Normal pressure hydrocephalus: Difference between revisions
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*Memory loss and [[dementia]] symptoms may be mild, subtle | *Memory loss and [[dementia]] symptoms may be mild, subtle | ||
*[[urinary incontinence|Incontinence]] is usually later stage, though sensation of urinary urgency is usually present before incontinence | *[[urinary incontinence|Incontinence]] is usually later stage, though sensation of urinary urgency is usually present before incontinence | ||
*Usually do ''not'' have symptoms of increased intracranial pressure, such as headache, nausea, vomiting, visual loss | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 21:48, 26 March 2020
Background
- Possible reversible cause of dementia
- CSF buildup in the ventricles leading to increased intracranial pressure with edema of the periventricular white matter and corona radiata
- Sacral motor nerve fibers that produce gait instability; incontinence ensues when compressed
Clinical Features
- Gait disturbance is most common and earliest finding
- "Glue-footed" gait: move slowly, take small steps, often wide base, with difficulty turning
- Memory loss and dementia symptoms may be mild, subtle
- Incontinence is usually later stage, though sensation of urinary urgency is usually present before incontinence
- Usually do not have symptoms of increased intracranial pressure, such as headache, nausea, vomiting, visual loss
Differential Diagnosis
- Alzheimer's
- Stroke
- Parkinson's disease
- Electrolyte abnormality
- Malignancy
- Uremic encephalopathy
- Hydrocephalus ex vacuo (diffuse cerebral atrophy on CT)
Evaluation
Management
- Diagnostic and therapeutic large volume CSF removal
- Additional work up warranted for surgical candidate[1] [2]
- Assessment for Surgical CSF shunting
Disposition
- Workup typically is extensive and performed as an outpatient.
- Refer to neurosurgery
Also See
References
- ↑ 1.0 1.1 Schneck MJ. Normal pressure hydrocephalus. Medscape. Retrieved 8/4/2016
- ↑ Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008 Sep;8(5):371-6.