Normal pressure hydrocephalus

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
  • Memory loss and dementia symptoms may be mild, subtle
  • Incontinence is usually later stage, though sensation of urinary urgency is usually present before 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

  • 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. 1.0 1.1 Schneck MJ. Normal pressure hydrocephalus. Medscape. Retrieved 8/4/2016
  2. Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008 Sep;8(5):371-6.