Normal Pressure Hydrocephalus

More commonly seen in the elderly.  It is thought to begin as a classic ‘high pressure’ hydrocephalus in which the ICP gradually falls to cause NPH, however, the mechanism is not 100% certain.

Patients do not commonly present with symptoms of hydrocephalus (e.g. vomiting, headache) but instead present classically with Adam’s Triad:

  • Dementia
  • Urinary Incontinence
  • Ataxia/gait apraxia

which comes on slowly over a few months.  There are large ventricles seen on CT but CSF pressure is often normal.  A VP shunt is often useful at resolving the hydrocephalus but many patients’ symptoms do not improve.  Therefore, the risks/benefits of performing a shunt procedure should be considered carefully in these patients.


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