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Normal pressure hydrocephalus (NPH)

  • Alternative Names

    Hydrocephalus - idiopathic; Hydrocephalus - adult; Hydrocephalus - communicating; Extraventricular obstructive hydrocephalus


    The symptoms often begin slowly.

    A person needs to have three symptoms to be diagnosed with normal pressure hydrocephalus:

    • Changes in the way a person walks: difficulty when beginning to walk (gait apraxia), feet held wider apart than normal, shuffling of the feet, unsteadiness
    • Slowing of mental function: forgetfulness, difficulty paying attention, apathy or no mood
    • Problems controlling urine (urinary incontinence), and sometimes controlling stools (fecal incontinence)

    Sudden falls without a loss of consciousness or other symptoms (drop attacks) may occur early in the illness.

    Note: Many of these symptoms are common in the elderly, and may be caused by other conditions.

    Signs and tests

    An examination shows walking (gait) changes related to the pressure placed on parts of the brain. Deep tendon reflexes may be increased in the lower legs.

    Tests include:

    • Lumbar puncture (spinal tap) with careful testing of walking before and after the spinal tap
    • Head CT scan or MRI of the head