Normal Pressure Hydrocephalus: Causes, Treatment


Hydrocephalus is a condition in which an abnormal amount of cerebral spinal fluid (CSF) accumulates in the ventricles. And normal pressure hydrocephalus (NPH) is a type of hydrocephalus. It’s different from other types of hydrocephalus for its slow development and normal pressure in the brain. NPH often affects the parts of brain that control the legs, the bladder, and the “cognitive” mental processes.

Normal pressure hydrocephalus occurs most commonly in people over the age of 60. It is estimated by some experts that NPH affects up to 750,000 people in the U.S, leading to at least 5% of dementia nationwide.


Researchers haven’t fully known the
exact causes of normal pressure hydrocephalus. However, some studies have found
that NPH may be related to:

  • weakening of veins
  • swelling of the brain’s white matter

Secondary form NPH is deteriorated by other
conditions, including

  • impaired absorption of cerebral spinal fluid
  • hemorrhage (bleeding in the brain)
  • mass lesions
  • meningitis
  • traumatic brain injury
  • brain infection
  • tumor or complications from surgery


At first, the symptoms of normal pressure hydrocephalus are very subtle,
but they will become noticeable gradually as the disease progresses.

The main symptoms of NPH include:

  • Difficulty walking.
  • Mild dementia.
  • Decline in thinking skills.
  • Loss of bladder control.

Minor symptoms in early NPH include:

  • dizziness
  • difficulty in walking slopes or stairs
  • difficulty in rising or sitting on a chair


It can be difficult to diagnose normal pressure hydrocephalus at its early
stage, because it presents similar symptoms to other diseases. Usually, one or
more of the following tests are done for a diagnosis of NPH:

Brain imaging

Like diagnosing any other neurodegenerative
disease, imaging tests of the brain are helpful. Examples of these include:

  • CT scan
  • PET scan
  • MRI.

Neuropsychological assessment

A mini-mental state examination will be used
to test the patient’s cognitive function. Other assessments used to test the patient’s
attention and executive function are:

  • digit spat spatial span
  • word fluency test
  • frontal assessment battery tests

Invasive Diagnostic Tests

Invasive diagnostic tests help to confirm the diagnosis of NPH.
These tests include:

  • Lumbar tap test
  • Lumbar drainage


Currently, there is no
any treatment that permanently cures normal pressure hydrocephalus. However, several
ways of treatment may help improve the patient’s health.

Surgical treatment

One surgical treatment called
cerebrospinal fluid removal test, may provide relief for patients. In this
procedure, doctors remove a large amount of spinal fluid from the patient with
a shunt in the brain to look for any improvements.

Non-surgical treatment

Although there isn’t any
non-surgical treatment that turns out to be effective for patients, they may still
try some remedial measures to:

  • relieve mood and behavioral problems
  • cope with physical problems such as incontinence and walking difficulties
  • maximize physical, mental, and social functioning.

Keywords: Normal Pressure Hydrocephalus.

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