Normal pressure hydrocephalus

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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
  • Memory loss
  • Incontinence

Differential Diagnosis

  • Alzheimers
  • Stroke
  • Parkinson's Disease
  • Electrolyte abnormality
  • Malignancy
  • Uremic encephalopathy
  • Hydrocephalus ex vacuo (diffuse cerebral atrophy on CT)

Evaluation

  • CBC
  • Chem 7
  • LP: normal opening pressure
    • Symptom improvement supports diagnosis[1]
  • CT brain

Management

  • 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. ↑ 1.0 1.1 Schneck MJ. Normal pressure hydrocephalus. Medscape. Retrieved 8/4/2016 Cite error: Invalid <ref> tag; name "medscape" defined multiple times with different content
  2. ↑ Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008 Sep;8(5):371-6.
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