Normal pressure hydrocephalus (NPH)

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Central nervous system

Ventricles of the brain

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

The symptoms often begin slowly.

A person needs to have three symptoms to be diagnosed with normal pressure hydrocephalus:

• Changes in the way a person walks: difficulty when beginning to walk (gait apraxia), feet held wider apart than normal, shuffling of the feet, unsteadiness
• Slowing of mental function: forgetfulness, difficulty paying attention, apathy or no mood
• Problems controlling urine (urinary incontinence), and sometimes controlling stools (fecal incontinence)

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Sudden falls without a loss of consciousness or other symptoms (drop attacks) may occur early in the illness.

Note: Many of these symptoms are common in the elderly, and may be caused by other conditions.

An examination shows walking (gait) changes related to the pressure placed on parts of the brain. Deep tendon reflexes may be increased in the lower legs.

Tests include:

• Lumbar puncture (spinal tap) with careful testing of walking before and after the spinal tap
• Head CT scan or MRI of the head

Review Date: 03/09/2010
Reviewed By: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).