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Normal pressure hydrocephalus (NPH) Health Article

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Definition

Normal pressure hydrocephalus (NPH) is a rise in cerebrospinal fluid (CSF) in the brain that affects brain function.

Alternative Names

Hydrocephalus - idiopathic; Hydrocephalus - adult; Hydrocephalus - communicating; Extraventricular obstructive hydrocephalus

Causes, incidence, and risk factors

Normal pressure hydrocephalus (NPH) is a form of hydrocephalus, also known as "water on the brain," which means there is too much fluid pressing on the brain.

NPH can occur without a known cause, or it may be caused by any condition that blocks the flow of cerebrospinal fluid (CSF). The fluid-filled chambers (ventricles) of the brain enlarge to fit the increased volume of CSF. They press down on and damage or destroy brain tissue.

Risk factors include:

CSF is produced in normal amounts in these conditions, but it is prevented from being reabsorbed normally.

NPH is thought to account for about 5% of all dementias.

Symptoms

The symptoms often begin slowly.

Early symptoms include:

  • Changes in gait, including inability to begin walking (gait apraxia)
  • Sudden fall without loss of consciousness or other symptoms (drop attacks)
  • Unsteady walking
  • Weakness of the legs

Symptoms as the disorder gets worse:

Signs and tests

An examination shows walking (gait) changes related to the damage in the brain. Deep tendon reflexes may be increased in the lower legs.

Tests include:

Treatment

The goal of treatment is to improve symptoms. The treatment of choice is surgery to place a tube called a shunt that routes the excess CSF out of the brain ventricles.

Treatment may vary depending on the symptoms and how much the therapy relieves them.

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Reviewer Info: Luc Jasmin, MD, PhD, Departments of Anatomy & Neurological Surgery, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; ADAM Health Illustrated Encyclopedia, 02/13/2008
 
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