Normal Pressure Hydrocephalus (“NPH”)

NPH is a disorder that involved the impaired reabsorption of cerebrospinal fluid (CSF). The problem starts slowly and can involve problems with memory, walking, and ability to control urination. These three key components are not always all present in every patient. The diagnosis of NPH is made first by identifying these symptoms and usually ordering scans.

A CT scan or MRI of the brain is usually ordered to make sure no other problems are present. Other disorders can sometimes look like NPH. The most important to distinguish are Alzheimer’s Disease. Others to consider are blood clots, brain tumors, and metabolic disorders. The MRI usually shows the fluid collecting spaces of the brain are enlarged with CSF.

With the help of a team of experienced clinicians, a lumbar puncture or drain placement may be ordered. Working together, neurologists and neurosurgeons help determine if the diagnosis is NPH, and then if the person may be a candidate for treatment.

The key treatment for NPH is CSF shunting. CSF shunting is the creation of an artificial path for the excess CSF to be siphoned off into another body space. Most commonly, an operation is completed that implants a special drainage system, known as a shunt that helps reduce the amount of CSF inside the brain.

The ventriculoperitoneal shunt (VP shunt) is all under the skin. The beginning part of the shunt is implanted into the ventricles, the fluid filled spaces of the brain. The drain is connected to a valve that can be adjusted to regulate the pressure of the fluid drained off. Most commonly, the last part of the shunt is placed in the abdomen. Other places include the chest and sometimes the great veins in the chest.

The operation is done with the patient asleep, in the hospital. Patients often take some time to show benefit. Fine-tuning of the amount of drainage is often necessary to achieve the optimal balance for the patient.

Not all the symptoms of NPH respond to the shunting. Most commonly, the urinary problems improve, and oftentimes the memory and walking get better as well. Every patient is different and not all symptoms will respond equally. It is best to have a detailed discussion with your surgeon so all the parts of the treatment, including the benefits risks, and alternatives are made clear.

If you suspect you or your loved one has NPH, talk to you doctor. You may need to have imaging done and by seen by a specialist.

This column serves is informational only. It should not be used in diagnosis, treatment, or evaluation of treatment efficacy. If you need more information, speak to your doctor or see these other online resources.

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