Normal Pressure Hydrocephalus

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Normal pressure hydrocephalus (NPH) is an accumulation of cerebrospinal fluid (CSF) that causes the ventricles in the brain to become enlarged, sometimes with little or no increase in intracranial pressure (ICP). In most cases of NPH, the cause of blockage to the CSF absorptive pathways is unclear. The name for this condition, ’normal pressure hydrocephalus,‘ originates from Dr. Salomon Hakim’s 1964 paper describing certain cases of hydrocephalus in which a triad (a group of three) of neurologic symptoms occurred in the presence of ’normal‘ CSF pressure –  gait disturbancesdementia, and impaired bladder control. These findings were observed before continuous pressure-recording techniques were available. The phrase ‘normal pressure’ is misleading as many patients experience fluctuations in CSF pressure that range from high to low and are variable within those parameters. However, normal pressure hydrocephalus (NPH) continues to be the common name for the condition.

Who develops Normal Pressure Hydrocephalus?

NPH is most commonly seen in older adults.

  • It is estimated that more than 700,000 Americans have NPH, but less than 20% receive an appropriate diagnosis.
  • Without appropriate diagnostic testing, NPH is often misdiagnosed as Alzheimer’s disease or Parkinson’s disease, or the symptoms are attributed to the aging process.
  • NPH is one of the few causes of dementia that can be controlled or reversed with treatment.

Click here to watch our video WHAT IS NPH?
Click here to download our booklet About Normal Pressure Hydrocephalus.

18 Comments for : Normal Pressure Hydrocephalus
    • Laura Glick
    • May 24, 2017

    My mother passed away a few months ago and I have a strong feeling that the delayed diagnosis and lack of treatment of NPH contributed to her extreme decline in health. For years, I knew something was wrong, but medical professionals would pass her symptoms and complications off as aging and dementia. I am heartbroken. She was 66. She was amazing and what makes it worse is knowing that her last years didn’t have to be the way they were had she been correctly diagnosed and treated for NPH. I want to become an advocate for people with NPH and increase awareness of the disease. If anyone knows how I can get more involved, please contact me.

    • Pat
    • May 10, 2017

    I was diagnosed with normal pressure hydrocephalus today after a CT scan with and without iodine injection. I have slight trouble with balance, and so far no memory or continence issues. I want to put off getting the shunt procedure. Do you have any suggestions about that? Thank you for any input.

  1. Reply

    I have been recently diagnosed with normal pressure hydrocephalus. I am getting my shunt put in in a week. I am wondering what the challenges are also how people cope and deal with living with a shunt.
    I am nervouse about the operation to put it in. Any advice welcome.

      • Jeanne Hutchings
      • May 3, 2017

      My husband had his shunt placed almost 2 years ago and it was like a switch was flipped, the improvement in his gait and mental capacity. I have noticed some dementia symptoms as I am a registered nurse . His shunt has been adjusted once since surgery . I wish you the best with your surgery and recovery.

  2. Reply

    I live in the Boston, MA area. I was diagnosed with NPH by a wonderful neurologist (who was actually treating me for Ideopathic peripheral Neuropathy when he “discovered” the NPH). I had shunt surgery in January 2017 at Massachusetts General Hospital and have experienced notable improvements in gait, memory, and mental health. The shunt has been adjusted once since surgery. Does anyone know of an NPH support group in eastern MA?

    • Pat
    • March 27, 2017

    My husband has been diagnosed with NPH as he has an unusual gait and has balancing issues. That is the only issues as this time. He is comtemplating having a shunt but concerned as to the side effects and if he will have a positive outcome.

    • Reply

      My Mom was diagnosed with NPH last year. She had a shunt in February and we are already seeing great improvements. It’s nice to have her back

    • Pat
    • March 27, 2017

    It took several months to diagnose NPH. My walking deteriorated quickly & I was using a cane. I had VP shunt surgery one month ago today. I had severe nausea & vomiting for a few days after the surgery . However, after adjusting the flow rate, I’ve had no more nausea, etc. Walking has improved, as have cognition & incontinence.

    Does anyone suggest getting a medical alert card or bracelet?

      • June
      • April 26, 2017

      A few years ago I was caught in an enviroment where those are unfamiliar with NPH and VP shunt placement.. when the sunt failed they were completely lost. Yes, I highly recommend weari g a medical id bracelet.

  3. Reply

    My husband was diagnosed 7 yrs ago. He has had several adjustment​s on his shunt. Three weeks ago, he has had some recent declines in his walking and mental recalls. We don’t understand what is happening.? Can anyone help us in this matter? Are there any support group available?

  4. Reply

    My husband was diagnosed with NPH almost 2 yrs. ago. He walks very slowly now and needs either a cane or a walker. His memory has declined in that time and his thinking process is most certainly compromised. We hesitate about the shunt because of the poor results–only 25-75% have SOME help, but it is the only recourse we know there is for treatment. From last years MRI and test results in appears that his condition is only slowly deteriorating although I see much change in his condition since last year. Is there a particular website or association besides this one where additional updated info is available?

    • Reply

      We had the shunt done 7 yrs ago and things improved with work on cognitive area as needed. Now it appears to be happening again. What are you doing now?

    • Elizabeth
    • March 19, 2017

    I have recently been diagnosed with nph and am going to have surgery. Any recommendations for physical therapy following the surgery?

    • Reply

      Physical Therapy after shunt surgery made a big difference.

    • Barbara Brown
    • June 20, 2016

    I have dealt with NPH for over 8 years as a caretaker. If I wrote a big it would be a guaranteed best seller. I see people almost daily that I recognize the NPH symptoms affecting them and will stop and talk with them and tell them about NPH. Several have gone for tests and had the shunt put in and walked off the operating room table. Not enough information is available or stories published regarding NPH. Knowledge is the lifesaving power to correct those that may be afflicted with it and have it blamed on Alzheimers, Dimentia or Parkinsons. So sad.

      • Jan
      • January 27, 2017

      Hi Barbara
      I am really worried about my mum. She is a very youthful 68. Recently retired from a very stressful job. Showing signs of PSP but the doctors have not given a diagnosis yet. Her symptoms are: slowness in movement, difficulty finding words and slurring, forgetfulness, gaze problems. Do you think NPH is to be ruled out based on these symptoms or is it possible to have these symptoms with NPH? Her MRI and DaTSCAN were normal

      • Jean Cary
      • February 11, 2017

      I have NPH and was lucky enough to be diagnosed after about 4 years of worsening symptoms. (not able to be diagnosed by university of Pennsylvania)

      I was diagnosed by by brother’s DO when I came to Las Vegas to help him with his medical issues.

      I’m convinced that a lot of folks, including some in the memory care facility where I’m staying now, could be helped by an accurate diagnosis and treatment.

      As soon as I get into my next placement, I want to add my efforts to advocating for greater awareness of NPH. For now, I’m trying to get into an assisted living program offering a variety of services that will help me improve further. I am interested in more information about the personal experiences that patients and caregivers can offer, such as how long it’s taken for improvement,etc.

      PS, I’ve worked for many years, most recently as a disability lawyer.

      • Jean
      • March 14, 2017

      I agree that the condition is not diagnosed enough, given what can happen to some folks who become extremely disabled without treatment, as happened to me. Fortunately, I was able to get surgery and improved, but I suffered the effects of lack of treatment.

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