Normal Pressure Hydrocephalus Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus

Hydrocephalus refers to a condition in which the cerebrospinal fluid that surrounds, protects and nourishes the brain is unable to drain, resulting in a buildup that causes the ventricles (cavities) in the brain to become enlarged.

“Normal pressure” refers to the fact that, in some cases, this buildup occurs without changing the normal intracranial (within the brain) pressure.


NPH is generally distinguished by the presence of three specific symptoms. These symptoms do not always appear simultaneously and can be present in varying degrees.

  • You may have differences in the way you walk. Because the condition can interfere with your balance, you may adopt a wide-based, short-stepped walk, as if you are shuffling. You may also find yourself unable to walk or stand.
  • You may exhibit signs of mild dementia, becoming forgetful and disinterested in daily activities, and having difficulty performing ordinary tasks.
  • You may experience greater urgency or frequency to your urinary habits, or you may become incontinent.

These symptoms are sometimes seen as indicators of Parkinson’s or Alzheimer’s disease, or even of normal aging.



The cause for primary NPH — with no other symptoms or conditions — is unknown. Secondary NPH — when the condition is the result of something else — can be caused by something that happens to your head or brain: an injury or surgery, a hemorrhage or infection, a tumor or cysts.


Living Better

The most important thing about normal pressure hydrocephalus is to get the correct diagnosis so that your symptoms can be evaluated properly and treated. Early diagnosis and treatment often results in improvement or resolution of symptoms.

With this condition, you may be coping with physical limitations such as slow or unsteady walking, urinary issues and other problems that make social interactions upsetting or difficult. A physical therapist can help you find ways to achieve better balance, and an occupational therapist can help you figure out solutions to any daily tasks that have become difficult.


Exams and Tests

At St. Luke’s Center for Neuroscience, your physician will perform a thorough physical exam and ask you specific questions about the symptoms you’ve been having and how long you’ve had them. The most usual test to administer is a magnetic resonance imaging (MRI) scan, whose three-dimensional images can show your health care team what is happening to the tissues and structures of your brain. A computed tomography (CT) scan might also be used.

Other tests, more specific to this condition, are those that involve measurement of your cerebrospinal fluid. These tests can be performed in various ways, including intracranial pressure monitoring and lumbar puncture.



If your symptoms are mild, your St. Luke’s physician may decide to monitor your situation; you may experience no increase in degree.

If your symptoms are or become moderate or severe, the general solution for this condition is to find a way to get the cerebrospinal fluid to drain. This involves surgery.

Before surgery, your physician may want to do a test to find evidence that it will reach the intended goal. To this end, your gait may be tested; a spinal tap done to drain excess fluid; and then your gait is tested again. This way, your symptoms could be measured before and after the drainage to see if it has achieved the desired result.

A cerebral shunt may be recommended to relieve pressure on the brain caused by fluid accumulation. Another minimally invasive procedure is called endoscopic third ventriculostomy.

If you are not a candidate for surgery, your physician may treat you with medicine that can help alleviate some mood or behavior issues that have been brought on by the condition. You may see occupational or physical therapists for help with daily tasks or walking.