Normal pressure hydrocephalus (NPH)

Low urgency
--

A disease in which the volume of cerebrospinal fluid bathing the brain and spinal cord is increased. It receives the adjective normotensive because the increase in fluid is not accompanied by an increase in intracranial pressure.

The triggering cause is unknown but a higher incidence has been described in people with a history of brain aneurysm, meningitis or brain surgery.

The triad of symptoms includes reduced intellectual capacity, difficulty walking and urinary incontinence.

It is diagnosed by clinical questioning and a complete neurological examination. Cerebrospinal fluid analysis and an imaging test (computed tomography or magnetic resonance imaging) will be performed to confirm the diagnosis.

Treatment is aimed at removing cerebrospinal fluid from the cranial cavity. A cranial drain will be implanted with an outlet into the abdominal peritoneum. 

Bibliographic references
  1. Neill R Graff-Radford. Normal pressure hydrocephalus. UpToDate. Mayo 2016
  2. Krauss JK. Normal pressure hydrocephalus: survey on contemporary diagnostic algorithms and therapeutic decision-making in clinical practice. Acta Neurochir (Wien) 2004; 146:379.
  3. Tisell M. National and regional incidence of surgery for adult hydrocephalus in Sweden. Acta Neurol Scand 2005; 112:72.
  4. Klassen BT. Normal pressure hydrocephalus: how often does the diagnosis hold water? Neurology 2011; 77:1119.
  5. Vanneste JA. Diagnosis and management of normal-pressure hydrocephalus. J Neurol 2000; 247:5.
  6. Hebb AO. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 2001; 49:1166.
Author
Dr. Patricia Sánchez
Copyright
© TeckelMedical 2026

Symptoms

    Urinary incontinence


    Deterioration of intellectual and/or motor abilities


    Defecate involuntarily


    Difficulty walking


    Loss of balance that leads to frequent falls

Symptoms to watch out for

Fever (temperature higher than 100.4 ºF)
Headache
Loss of sensibility and/or motility in limbs
Reduction in the level of consciousness