Normal pressure hydrocephalus (NPH)

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Central nervous system Ventricles of the brain

Overview Symptoms Treatment Prevention

Normal pressure hydrocephalus (NPH)

Early symptoms include:

• Changes in gait, including inability to begin walking (gait apraxia)
• Unsteady walking
• Weakness of the legs
• Sudden fall without loss of consciousness or other symptoms (drop attacks)

• Dementia (loss of any or all brain functions, including movement, sensation, perception, and thought processes) -- originally mild, may progress to severe dementia
• No observable mood (flat affect)
• Apathy
• Withdrawn behavior
• Impaired memory
• Difficulty maintaining attention
• Decreased spontaneity
• Urinary or bowel incontinence (loss of control over function)
• Speech impairment

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) may show normal pressure of CSF in the spine.
• A head CT scan or MRI of head may show changes that indicate NPH.
• A RHISA scan (a nuclear scan using radioactivity) may show changes of the circulation within the brain, or reflux of CSF into the ventricles.

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