Normal Pressure Hydrocephalus (NPH) is a condition characterized by the enlargement of the brain ventricles due to the accumulation of cerebrospinal fluid (CSF) in the brain ventricles. CSF pressure is typically measured within normal range, but the accumulation leads to functional impairments in the brain.

Clinical Triad

NPH is typically seen in older individuals and is characterized by three primary symptoms:

• Gait Disturbance:
  Difficulty lifting feet off the ground (magnetic gait).
  Walking with slow, short steps and instability.

• Dementia:
  Impaired mental function.
  Decline in memory, attention, and problem-solving abilities.

• Urinary Incontinence:
  Loss of bladder control.
  Increased frequency and urgency of urination.

Etiology

• Primary (Idiopathic):
  The cause of NPH is unknown.

• Secondary:

  • Post-traumatic.

  • Subarachnoid hemorrhage or intracranial bleeding.

  • Meningitis or other infections.

Diagnostic Methods

• Magnetic Resonance Imaging (MRI):

  • Ventricular enlargement.

  • Lack of cortical atrophy.

• Computerized Tomography (CT):

  • To observe ventricular growth.

• Lumbar Puncture (CSF Drainage Test):

  • Improvement in symptoms after CSF drainage supports the diagnosis.

• Lumbar Pressure Measurement:

  • Normal CSF pressure (5-15 mmHg) is detected.

Treatment

• Surgical Treatment:

  • Ventriculoperitoneal (VP) Shunt:
    Redirects excess fluid from the brain ventricles to the abdominal cavity.

  • Lumboperitoneal Shunt:
    Transfers CSF from the lumbar region to the abdominal cavity.

• Medical Treatment:
  Provides temporary relief, typically used in patients who are not suitable for surgery.

Prognosis

• Early diagnosis and treatment significantly improve symptoms like gait disturbance and urinary incontinence.

• Cognitive symptoms such as dementia are less likely to improve significantly.

Regular follow-up and a multidisciplinary approach are critical in improving the patients' quality of life.