Normal pressure hydrocephalus (NPH)

Alternative names:

hydrocephalus - adult; hydrocephalus - communicating; hydrocephalus - idiopathic

Symptoms:

Early symptoms

• changes in gait (walking pattern):
  • feet appear stuck to the floor, unable to begin walking (gait apraxia)

• unsteady walking
• weakness of the legs
• sudden fall without loss of consciousness or other symptoms (drop attacks)

Symptoms of progression of the disorder:

• dementia (loss of any or all brain functions, including movement, sensation/perception, and "thinking"/cognitive functions)
  • originally mild, may progress to severe dementia

• no observable mood (flat affect)
• apathy
• withdrawn behavior
• impaired memory
• difficulty maintaining attention
• decreased spontaneity
• urinary incontinence
• bowel incontinence, loss of control over bowels
• urinary hesitancy (unable to begin urination)
• speech impairment

Signs and tests:

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

• A lumbar puncture (spinal tap) shows normal pressure of CSF in the spine.
• A head CT scan or MRI of head shows changes that indicate NPH.
• A RHISA scan may show changes of the circulation within the brain, reflux of CSF into the ventricles.