Normal pressure hydrocephalus (NPH)Definition Normal pressure hydrocephalus (NPH) is a brain disorder that occurs when the flow of cerebrospinal fluid is blocked. The fluid fills up within the brain, which in turn compresses brain tissue. The person may lose any or all brain functions controlled by the area of the brain that is compressed. Causes, incidence, and risk factors Normal pressure hydrocephalus (NPH) can be a reversible or treatable disorder. It is thought to account for about 5% of all dementias. The symptoms often begin gradually. NPH is a form of hydrocephalus, also known as "water on the brain", which means there is too much fluid compressing the brain. It can occur without identifiable cause, or it may be caused by any condition where the flow of cerebrospinal fluid (CSF) is blocked. The CSF is produced in normal amounts in this condition, but it is prevented from being normally re-absorbed. The ventricles (fluid-filled chambers) of the brain enlarge to accommodate the increased volume of CSF so the pressure of CSF, when measured by lumbar puncture (spinal tap), remains normal. Brain tissue is damaged or destroyed because of compression by the fluid-filled ventricles. If there is an identifiable cause and the cause can be corrected, the symptoms may reverse or at least stop getting worse. If there is no identifiable cause, the disorder is often progressive. Risk factors include disorders that may cause obstruction of the flow of CSF, such as closed head injury, surgery on the brain (craniotomy), meningitis or similar infections, and subarachnoid hemorrhage (bleeding from a blood vessel or aneurysm in the brain). Symptoms Early symptoms include:
Signs and tests An examination shows gait changes related to the damage within the brain. Deep tendon reflexes may be increased in the lower legs.
Treatment The goal of treatment is to improve symptoms. The surgical creation of a shunt that routes the CSF around the obstruction and back into the circulation is the treatment of choice. Symptomatic treatment may vary depending on the symptoms presented and the extent that symptoms are relieved by treatment. Expectations (prognosis) Prognosis is poor without medical intervention. Symptoms progress and the disorder results in death. Surgical treatment improves symptoms in about 50% of cases, with the best prognosis (probable outcome) for those with minimal symptoms. Other persons may have varying degrees of disability prior to death. Complications
Calling your health care provider Call your health care provider if symptoms indicate normal pressure hydrocephalus may be present. Call your health care provider if the condition of a person with NPH deteriorates to the point where you are unable to care for the person yourself. Go to the emergency room or call the local emergency number (such as 911) if a sudden change in mental status occurs, as this may indicate development of another disorder. Prevention Treating disorders associated with NPH may prevent its development in some cases. It may not be preventable in other cases, but early treatment may prevent severe symptoms. Illustrations
Page Content: Hydrocephalus - idiopathic; Hydrocephalus - adult; Hydrocephalus - communicating, "water on the brain" ; adult hydrocephalus; adult onset hydrocephalus; hydrocephalus in adult |