Normal-Pressure Hydrocephalus
Normal Pressure Hydrocephalus (NPH) is the
enlargement of the ventricles of the brain, without increased Cerebrospinal
Fluid (CSF) Pressure.
Unlike acute hydrocephalus, in which CSF pressure is amplified in the ventricles
of the brain and usually causes headaches, nausea, vomiting, and visual
impairments, NPH causes the symptoms as dementia, gait disturbance, and
urinary incontinence.
Because NPH is most common in patients over the age of 60, its symptoms
may be confused with Alzheimer's or Parkinson's diseases. Although NPH
causes deficiencies in short term memory and the gradual diminishing of
the thought process, it is not as encompassing as the memory loss that
is associated with Alzheimer's disease. Also, apraxia or visual loss does
not accompany NPH as may be the case in the previously mentioned diseases.
Because there is no known cause for NPH, it can be perplexing to diagnose
and treat properly. However, if the clinical symptoms -- dementia, gait
disturbance, and urinary incontinence -- are evident, the afflicted individual
and/or family should contact a neurologist. A complete neurological examination
with a Computed Tomography (CT) Scan or a Magnetic Resonance Imaging (MRI)
provides anatomic pictures of the ventricles and ensures that the CSF flow
is not blocked by a mass. This helps to exclude other potential causes
for the symptoms.
If diagnosis indicates that a person suffers with NPH, it can be effectively
treated with a CSF shunt. A shunt is a catheter made out of a pliable material
which directs CSF flow to a region (the abdominal cavity or the heart chamber)
to enable it to be absorbed into the bloodstream. However, the implantation
of a shunt is not risk-free. The immediate risks of shunting are related
specifically to the patient's age, anesthesia and subsequent cardiovascular
and pulmonary problems. Over the long term, shunts can malfunction -- causing
and resulting in infection and/or blockage -- and may have to be revised
or replaced.
Shunts are not a cure, but they can be a very effective way to treat NPH.
It is difficult to predict if a patient will benefit from a shunt. Because
of this, the decision to shunt is a critical one. CSF diversion with a
shunt may first improve the patient's gait abnormality and second the urinary
incontinence. It unfortunately may not be a remedy for the associated dementia.
NPH can be effectively managed by a neurologist to improve the quality
of life for an individual.