Normal Pressure Hydrocephalus (NPH)

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Initial Diagnosis

NPH may be diagnosed if you have difficulty walking, mental and bladder problems, and cerebrospinal fluid (CSF) levels that are higher than usual. However, you may not have all these symptoms at the same time.

Normal-pressure hydrocephalus (NPH) can be difficult to diagnose because the symptoms start gradually and are similar to those of more common conditions which also typically affect people in the same age range (> 65 years), such as Alzheimer’s disease.

It is very important to make a correct (differential) diagnosis because, unlike Alzheimer’s disease, the symptoms of NPH can be relieved with surgical treatment.

Your doctors will assess:

  • how you walk (your gait)
  • your mental ability
  • symptoms that affect your bladder control, such as urinary incontinence
  • the appearance of your brain (using scans, as described above)

Normal-pressure hydrocephalus (NPH) is a neurological condition that normally occurs in adults 55-years and older. NPH is an accumulation of cerebrospinal fluid (CSF), causing the ventricles of the brain to enlarge, in turn, stretching the nerve tissue of the brain causing a triad of symptoms

It’s often difficult to tell the difference because the symptoms of NPH are in many ways similar to those of Alzheimer’s or Parkinson’s. However, the feeling of feet glued to the floor, or difficulty walking is the first symptom to appear, in NPH. And it’s different from, for example, Parkinson’s tremors. In Alzheimer’s, memory loss and confusion tend to be early symptoms, whereas in NPH these appear later. Fortunately, once NPH is confirmed, chances are it can be treated.

Further, (CSF) tests may also be done to decide whether you would benefit from having surgery, such as a:

  • lumbar puncture
  • lumbar drainage test
  • lumbar infusion test