Normal pressure cephalus (NPH) is a condition that occurs when cerebrospinal fluid builds up inside the skull and presses on the brain.

Normal pressure hydrocephalus can affect several brain-related abilities, including:

• Thinking and concentration
• Memory
• Movement

There are two forms of normal pressure hydrocephalus, and they happen at equal rates. The two types are:

• Primary (idiopathic) NPH means that it isn’t happening because of another medical condition, and the cause is unknown. Experts suspect idiopathic NPH can involve one or more age-related issues with how the body makes, circulates, and reabsorbs cerebrospinal fluid. About half the cases of NPH are idiopathic.
• Secondary NPH happens when another medical condition affects how the body makes, circulates, or reabsorbs cerebrospinal fluid. Some examples of conditions that can cause secondary NPH include:
  • A brain aneurysm
  • Intracranial hemorrhage
  • Brain tumors, including cancer
  • Encephalitis or meningitis
  • Stroke
  • Traumatic brain injuries

Normal pressure hydrocephalus is usually difficult to diagnose because it shares several symptoms with dementia and similar age-related conditions. It is also common for NPH to happen at the same time as age-related conditions. About 30% of people with NPH also have Alzheimer’s or a similar degenerative brain disease.

The symptoms of NPH usually start gradually, and develop and worsen over three to six months. The three main symptoms of NPH are known as Hakim’s triad. Between 50% and 75% of people with NPH show all three symptoms at the same time. Hakim’s triad includes three types of symptoms, which include:

• Gait issues are the most likely of the three symptoms to occur. About 80% to 95% of people with NPH show this kind of symptom. Some of these symptoms may resemble movement-related symptoms of Parkinson’s disease, however, a key difference is that NPH symptoms typically only affect the legs and feet. If you have NPH, it often causes the following:
  • Trouble lifting your feet
  • Taking shorter and unsteady steps
  • Hesitating or walking uncertainly
• Urinary incontinence is when you lose control of your bladder, causing you to pee unintentionally. Early on, this can cause a strong urge to pee often that is difficult to control.
• Cognitive difficulties are the third key symptom of NPH and can appear as or cause any of the following:
  • Mental and physical slowness
  • Memory problems
  • Executive dysfunction
  • Emotional changes

A healthcare provider can diagnose NPH using a combination of methods that include:

• physical and neurological exams
• Asking questions about your medical history and symptoms
• diagnostic imaging, such as an MRI, cisternogram scan, and CT scans
• Lab tests, such as a spinal tap

Depending on your symptoms, a healthcare provider may recommend other tests to rule out conditions that have symptoms similar to NPH.

NPH is usually a treatable disease. The approach to treatment varies depending on whether it is primary/idiopathic or secondary NPH. Unlike most brain-related conditions, treating NPH rarely involves medications because NPH doesn’t respond to medications.

Primary/idiopathic NPH is usually treatable, with the most common and most effective treatment being surgery to implant a device called a shunt.

Secondary NPH may be curable, only if it happens because of a curable condition. The treatment for secondary NPH varies depending on the underlying cause. A healthcare provider is the best person to tell you about the possible treatments and what they recommend.

If you commonly experience symptoms of normal pressure hydrocephalus or other brain-related conditions, you can receive specialized treatment from a neurologist at Jamaica Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718)-206-7001.

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