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Pathophysiology of NPH

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Normal Pressure Hydrocephalus

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Abstract

Over the past decades, there have been various hypotheses and theories discussing the aetiology of Normal Pressure Hydrocephalus (NPH). This reversible form of dementia, as an entity characterised by the famous clinical triad of symptoms: gait impairment, urinary incontinence, and cognitive deficit, represents a complex vicious cycle of pathophysiological mechanisms simultaneously involving each other, rather than being a consequence of one well-defined cause. Despite a lot of effort to fully understand the pathogenesis of the disease, a clear cause and exact pathophysiological pathways remain unclear. Pathophysiological factors including the impairment of glymphatic system, reduced arterial pulsatility, associated metabolic and osmotic disbalances, astrogliosis, or neuroinflammation are known to contribute to the disease’s pathogenesis, and lead to NPH manifestation. In this chapter, we summarise both historical and current conceptions of NPH pathophysiology, in relation to typical clinical and radiological findings.

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Abbreviations

AQP:

Aquaporin

BBB:

Blood-brain barrier

CFAP:

Cilia- and flagella-associated protein

CI:

Confidence interval

CiNPHT:

Comprehensive idiopathic normal-pressure hydrocephalus theory

CNS:

Central nervous system

CSAS:

Cortical subarachnoid spaces

CSF:

Cerebrospinal fluid

DTI-ALPS:

Diffusion tensor image analysis along the perivascular space

ICP:

Intracranial pressure

iNPH:

Idiopathic normal pressure hydrocephalus

LIAS:

Late-onset idiopathic aqueductal stenosis

MRI:

Magnetic resonance imaging

NPH:

Normal pressure hydrocephalus

OR:

Odds ratio

OSA:

Obstructive sleep apnoea

PCD:

Primary cilia dyskinesia

sNPH:

Secondary normal pressure hydrocephalus

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This chapter was supported by the Ministry of Health of the Czech Republic institutional grant no. NU23-04-00551.

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  1. Department of Neurosurgery, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic

    Adéla Bubeníková, Petr Skalický & Ondřej Bradáč

  2. Department of Neurosurgery and Neuro-Oncology, 1st Medical Faculty, Charles University and Military University Hospital, Prague, Czech Republic

    Adéla Bubeníková & Ondřej Bradáč

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    Ondrej Bradac

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Bubeníková, A., Skalický, P., Bradáč, O. (2023). Pathophysiology of NPH. In: Bradac, O. (eds) Normal Pressure Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-031-36522-5_6

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