Skip to main content

Advertisement

SpringerLink
Log in

Normal pressure hydrocephalus: Diagnosis and treatment

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Normal pressure hydrocephalus (NPH) is a syndrome of gait dysfunction and enlarged cerebral ventricles in the absence of another cause. It is frequently accompanied by frontal and subcortical cognitive deficits and bladder detrusor overactivity. NPH is rare relative to other potential causes of these symptoms in the elderly, but timely diagnosis can lead to reversal of symptoms through ventricular shunting. There are many tests used to predict possible response to surgery, such as MRI of the brain, formalized neuropsychological and gait testing, large-volume lumbar puncture, and prolonged lumbar drainage, but no one test has been validated to rule out potential response to surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Conn HO: Normal pressure hydrocephalus: new complications and concepts. Pract Neurol 2007, 7:252–258.

    Article  PubMed  Google Scholar 

  2. Hakim S, Adams RD: The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965, 2:307–327.

    Article  PubMed  CAS  Google Scholar 

  3. Brean A, Eide PK: Prevalence of probable idiopathic normal pressure hydrocephalus in a Norwegian population. Acta Neurol Scand 2008 (in press).

  4. Marmarou A, Young HF, Aygok GA: Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Neurosurg Focus 2007, 22:E1.

    Google Scholar 

  5. Knopman DS, Petersen RC, Cha RH, et al.: Incidence and causes of nondegenerative nonvascular dementia: a population-based study. Arch Neurol 2006, 63:218–221.

    Article  PubMed  Google Scholar 

  6. Marmarou A, Young HF, Aygok GA, et al.: Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients. J Neurosurg 2005, 102:987–997.

    PubMed  Google Scholar 

  7. Bugalho P, Guimaraes J: Gait disturbance in normal pressure hydrocephalus: a clinical study. Parkinsonism Relat Disord 2007, 13:434–437.

    Article  PubMed  Google Scholar 

  8. Nowak DA, Topka HR: Broadening a classic clinical triad: the hypokinetic motor disorder of normal pressure hydrocephalus also affects the hand. Exp Neurol 2006, 198:81–87.

    Article  PubMed  Google Scholar 

  9. Krauss JK, Regel JP, Droste DW, et al.: Movement disorders in adult hydrocephalus. Mov Disord 1997, 12:53–60.

    Article  PubMed  CAS  Google Scholar 

  10. Sakakibara R, Kanda T, Sekido T, et al.: Mechanism of bladder dysfunction in idiopathic normal pressure hydrocephalus. Neurourol Urodyn 2007 [Epub ahead of print].

  11. Iddon JL, Pickard JD, Cross JJ, et al.: Specific patterns of cognitive impairment in patients with idiopathic normal pressure hydrocephalus and Alzheimer’s disease: a pilot study. J Neurol Neurosurg Psychiatry 1999, 67:723–732.

    PubMed  CAS  Google Scholar 

  12. Mataro M, Matarin M, Poca MA, et al.: Functional and magnetic resonance imaging correlates of corpus callosum in normal pressure hydrocephalus before and after shunting. J Neurol Neurosurg Psychiatry 2007, 78:395–398.

    Article  PubMed  Google Scholar 

  13. Hellstrom P, Edsbagge M, Archer T, et al.: The neuropsychology of patients with clinically diagnosed idiopathic normal pressure hydrocephalus. Neurosurgery 2007, 61:1219–1226; discussion 1227–1228.

    PubMed  Google Scholar 

  14. Bech-Azeddine R, Hogh P, Juhler M, et al.: Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting. J Neurol Neurosurg Psychiatry 2007, 78:157–161.

    Article  PubMed  CAS  Google Scholar 

  15. Golomb J, Wisoff J, Miller DC, et al.: Alzheimer’s disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response. J Neurol Neurosurg Psychiatry 2000, 68:778–781.

    Article  PubMed  CAS  Google Scholar 

  16. Vanneste JA: Diagnosis and management of normal-pressure hydrocephalus. J Neurol 2000, 247:5–14.

    Article  PubMed  CAS  Google Scholar 

  17. Wilson RK, Williams MA: Evidence that congenital hydrocephalus is a precursor to idiopathic normal pressure hydrocephalus in only a subset of patients. J Neurol Neurosurg Psychiatry 2007, 78:508–511.

    Article  PubMed  Google Scholar 

  18. Bateman GA: Vascular compliance in normal pressure hydrocephalus. AJNR Am J Neuroradiol 2000, 21:1574–1585.

    PubMed  CAS  Google Scholar 

  19. Krauss JK, Regel JP, Vach W, et al.: Vascular risk factors and arteriosclerotic disease in idiopathic normal-pressure hydrocephalus of the elderly. Stroke 1996, 27:24–29.

    PubMed  CAS  Google Scholar 

  20. Tarkowski E, Tullberg M, Fredman P, et al.: Normal pressure hydrocephalus triggers intrathecal production of TNF-alpha. Neurobiol Aging 2003, 24:707–714.

    Article  PubMed  CAS  Google Scholar 

  21. Li X, Miyajima M, Jiang C, et al.: Expression of TGF-betas and TGF-beta type II receptor in cerebrospinal fluid of patients with idiopathic normal pressure hydrocephalus. Neurosci Lett 2007, 413:141–144.

    Article  PubMed  CAS  Google Scholar 

  22. Sasaki H, Ishii K, Kono AK, et al.: Cerebral perfusion pattern of idiopathic normal pressure hydrocephalus studied by SPECT and statistical brain mapping. Ann Nucl Med 2007, 21:39–45.

    PubMed  Google Scholar 

  23. Momjian S, Owler BK, Czosnyka Z, et al.: Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain 2004, 127:965–972.

    Article  PubMed  Google Scholar 

  24. Klinge PM, Brooks DJ, Samii A, et al.: Correlates of local cerebral blood flow (CBF) in normal pressure hydrocephalus patients before and after shunting-A retrospective analysis of [(15)O]H(2)O PET-CBF studies in 65 patients. Clin Neurol Neurosurg 2008 (in press).

  25. Nakayama T, Ouchi Y, Yoshikawa E, et al.: Striatal D2 receptor availability after shunting in idiopathic normal pressure hydrocephalus. J Nucl Med 2007, 48:1981–1986.

    Article  PubMed  CAS  Google Scholar 

  26. Mocco J, Tomey MI, Komotar RJ, et al.: Ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus increases midbrain size: a potential mechanism for gait improvement. Neurosurgery 2006, 59:847–850; discussion 850–851.

    Article  PubMed  CAS  Google Scholar 

  27. Zhang J, Williams MA, Rigamonti D: Heritable essential tremor-idiopathic normal pressure hydrocephalus (ETINPH). Am J Med Genet 2008, 146:433–439.

    Article  CAS  Google Scholar 

  28. Relkin N, Marmarou A, Klinge P, et al.: Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005, 57:S4–S16.

    PubMed  Google Scholar 

  29. Kubo Y, Kazui H, Yoshida T, et al.: Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus. Dement Geriatr Cogn Disord 2008, 25:37–45.

    Article  PubMed  Google Scholar 

  30. Krauss JK, Regel JP: The predictive value of ventricular CSF removal in normal pressure hydrocephalus. Neurol Res 1997, 19:357–360.

    Article  PubMed  CAS  Google Scholar 

  31. Hebb AO, Cusimano MD: Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 2001, 49:1166–1184; discussion 1184–1186.

    Article  PubMed  CAS  Google Scholar 

  32. Williams MA, Thomas G, de Lateur B, et al.: Objective assessment of gait in normal-pressure hydrocephalus. Am J Phys Med Rehabil 2008, 87:39–45.

    Article  PubMed  Google Scholar 

  33. Walchenbach R, Geiger E, Thomeer RT, et al.: The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2002, 72:503–506.

    PubMed  CAS  Google Scholar 

  34. Burnett MG, Sonnad SS, Stein SC: Screening tests for normal-pressure hydrocephalus: sensitivity, specificity, and cost. J Neurosurg 2006, 105:823–829.

    Article  PubMed  Google Scholar 

  35. Bugalho P, Alves L: Normal-pressure hydrocephalus: white matter lesions correlate negatively with gait improvement after lumbar puncture. Clin Neurol Neurosurg 2007, 109:774–778.

    Article  PubMed  Google Scholar 

  36. Spagnoli D, Innocenti L, Bello L, et al.: Impact of cerebrovascular disease on the surgical treatment of idiopathic normal pressure hydrocephalus. Neurosurgery 2006, 59:545–552; discussion 545–552.

    Article  PubMed  Google Scholar 

  37. Sasaki M, Honda S, Yuasa T, et al.: Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI. Neuroradiology 2008, 50:117–122.

    Article  PubMed  Google Scholar 

  38. Palm WM, Walchenbach R, Bruinsma B, et al.: Intracranial compartment volumes in normal pressure hydrocephalus: volumetric assessment versus outcome. AJNR Am J Neuroradiol 2006, 27:76–79.

    PubMed  CAS  Google Scholar 

  39. Bradley WG Jr, Scalzo D, Queralt J, et al.: Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology 1996, 198:523–529.

    PubMed  Google Scholar 

  40. Scollato A, Tenenbaum R, Bahl G, et al.: Changes in aqueductal CSF stroke volume and progression of symptoms in patients with unshunted idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol 2008, 29:192–197.

    Article  PubMed  CAS  Google Scholar 

  41. Kahlon B, Annertz M, Stahlberg F, et al.: Is aqueductal stroke volume, measured with cine phase-contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal pressure hydrocephalus? Neurosurgery 2007, 60:124–129; discussion 129–130.

    PubMed  Google Scholar 

  42. McGirt MJ, Woodworth G, Coon AL, et al.: Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus. Neurosurgery 2005, 57:699–705; discussion 699–705.

    Article  PubMed  Google Scholar 

  43. Kahlon B, Sjunnesson J, Rehncrona S: Long-term outcome in patients with suspected normal pressure hydrocephalus. Neurosurgery 2007, 60:327–332; discussion 332.

    PubMed  Google Scholar 

  44. Marmarou A, Bergsneider M, Klinge P, et al.: The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery 2005, 57:S17–S28.

    Article  PubMed  Google Scholar 

  45. Stein SC, Burnett MG, Sonnad SS: Shunts in normal-pressure hydrocephalus: do we place too many or too few? J Neurosurg 2006, 105:815–822.

    Article  PubMed  Google Scholar 

  46. Williams MA, Sharkey P, van Doren D, et al.: Influence of shunt surgery on healthcare expenditures of elderly fee-for-service Medicare beneficiaries with hydrocephalus. J Neurosurg 2007, 107:21–28.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Rochester School of Medicine, 1351 Mt. Hope Avenue, Suite 100, Rochester, NY, 14620, USA

    David Shprecher

Authors
  1. David Shprecher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason Schwalb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roger Kurlan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Shprecher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shprecher, D., Schwalb, J. & Kurlan, R. Normal pressure hydrocephalus: Diagnosis and treatment. Curr Neurol Neurosci Rep 8, 371–376 (2008). https://doi.org/10.1007/s11910-008-0058-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-008-0058-2

Keywords

Search

Navigation