A Family Doctor's Tale - NORMAL PRESSURE HYDROCEPHALUS

DOC I HAVE NORMAL PRESSURE HYDROCEPHALUS

The importance of normal pressure hydrocephalus is often most of the patients do not realize its presence until the symptoms of gait, dementia and incontinence begin to worry the family.

In most cases a MRI of the brain will confirm the diagnosis and treatment is by using a shunt to divert the excess fluids in the brain to the peritoneal cavity.


Normal Pressure Hydrocephalus(NPH) is an abnormal accumulation of cerebrospinal fluid in the cavities of the brain.



Normal Pressure Hydrocephalus occurs in adults of 55 years old and above.

The accumulation of cerebrospinal fluid is gradual leading to enlargement of the cavities in the brain called ventricles.

This in turn stretches the nerve tissues of the brain giving rise to 3 main neurological disturbances in the brain which is characteristic of NPH.



In most cases the cause is unknown.

In the remaining cases, the secondary causes can be found:

1. Brain infection can cause damage to brain tissues and the resulting cell damage can increase fluid in the brain

2. Stroke may damage brain cells resulting in damaged brain tissues and increase fluid in the brain

3. Trauma and head injury may damage brain cells similar to above

4. Brain tumors are another cause of increased fluid in the brain



Onset is slow and gradual but typically the following symptoms are present:

1.Gait disturbance


Difficulty in walking or balancing

2.Cognitive impairment


mild dementia

3.Urinary Incontinence


Problems with bladder control and hence incontinence

Diagnosis of Normal Pressure Hydrocephalus is  confirmed by:


1.History of the above 3 symptoms

2.Physical examination shows the neurological deficits:
difficulty in walking

mild dementia

urinary incontinence

3.MRI of brain shows the presence of enlarged ventricles in the brain

Treatment of Normal Pressure Hydrocephalus is by:


NPH cannot be cured but its symptoms can be controlled.

Treatment is by surgery using a shunt to divert the excessive fluid in the brain to the peritoneal cavity.

Complications of Normal Pressure Hydrocephalus are:

1. Dementia

2. Disability

3. Disturbed urinary and bowel function.

Prognosis of Normal Pressure Hydrocephalus:


With early diagnosis and treatment, symptoms can be partially or fully reversed leading to resumption of a normal life.

With the use of the shunt, symptoms may disappear within days or at most a few months.

There is dramatic improvement in the first week in mild cases.

Some adjustments of the valve are often needed before the correct setting is obtained for the individual.