Normal Pressure Hydrocephalus: Clinical Approach and Practical Considerations

Normal pressure hydrocephalus is defined as an abnormal cerebrospinal fluid accumulation in the ventricles. The condition is more commonly seen in the elderly population. It is present in more than 700,000 Americans between the ages of 60 - 70, but less than 20% receive an accurate diagnosis. It may be idiopathic without a known cause or the result of any circumstance that interferes with the normal cerebral spinal fluid flow (i.e., subarachnoid hemorrhage, head trauma, infection, tumor, or complications from surgery). Clinical manifestations include the presence of cognitive impairment, gait disturbance, and urinary incontinence. The diagnosis of normal pressure hydrocephalus is complex since it may present similar symptoms to those associated with other neurological conditions, particularly dementia syndromes. Therefore, a combination of classic clinical presentation, brain imaging findings, and dynamic evaluation of cerebrospinal fluid is necessary to identify this disorder. Depending on the patient’s characteristics, medical/conservative treatment or ventriculoperitoneal surgical shunting can be effective management methods. On an individual basis, the prognosis of the disease and the outcome of treatment may vary.