Normal Pressure Hydrocephalus

Clinical Triad: Gait Disturbance, Memory Loss, Bladder Dysfunction

NORMAL PRESSURE HYDROCEPHALUS frequently presents with various degrees of the following three complaints: Worsening Gait, Worsening Memory and Increasing Urinary Incontinence.

GAIT DISTURBANCE: Usually a slow, shuffling, hesitant gait with a history of frequent falls is the usual complaint. The walking is sometimes confused with a Parkinson Disease type of gait.

MEMORY LOSS: People begin "forgetting" more and more. It may appear as an early Alzheimer type of dementia or that he or she is "just getting old..."

BLADDER DYSFUNCTION: People complain that the bladder medication which seemed to work initially is no longer working. Bladder incontinence worsens.

MRI Scans And Normal Pressure Hydrocephalus

MRI Showing NPH MRI Showing NPH

The MRI scan usually demonstrates large ventricles. In elderly individuals there may be cerebral atrophy (shrinkage of the gray matter). Cerebral Spinal Fluid will fill up the space of a brain with atrophy. However, in NPH, the enlarged fluid space (ventricles) are enlarged out of proportion to the cerebral atrophy..

Treatment of Normal Pressure Hydrocephalus

Response to placement of a Ventricular-Peritoneal Shunt can be quite variable, although I have seen dramatic improvement frequently. Some patients have improved in several days, others take several months. Unfortunately, not all patients respond to treatment. However, with programmable shunts and the choice of multiple settings, adjusting the setting increases the probability for optimal outcome.