Normal Pressure Hydrocephalus (NPH) is the
enlargement of the ventricles of the brain, without increased Cerebrospinal
Fluid (CSF) Pressure.
Unlike acute hydrocephalus, in which CSF pressure is amplified in the ventricles of the brain and usually causes headaches, nausea, vomiting, and visual impairments, NPH causes the symptoms as dementia, gait disturbance, and urinary incontinence.
Because NPH is most common in patients over the age of 60, its symptoms may be confused with Alzheimer's or Parkinson's diseases. Although NPH causes deficiencies in short term memory and the gradual diminishing of the thought process, it is not as encompassing as the memory loss that is associated with Alzheimer's disease. Also, apraxia or visual loss does not accompany NPH as may be the case in the previously mentioned diseases.
Because there is no known cause for NPH, it can be perplexing to diagnose and treat properly. However, if the clinical symptoms -- dementia, gait disturbance, and urinary incontinence -- are evident, the afflicted individual and/or family should contact a neurologist. A complete neurological examination with a Computed Tomography (CT) Scan or a Magnetic Resonance Imaging (MRI) provides anatomic pictures of the ventricles and ensures that the CSF flow is not blocked by a mass. This helps to exclude other potential causes for the symptoms.
If diagnosis indicates that a person suffers with NPH, it can be effectively treated with a CSF shunt. A shunt is a catheter made out of a pliable material which directs CSF flow to a region (the abdominal cavity or the heart chamber) to enable it to be absorbed into the bloodstream. However, the implantation of a shunt is not risk-free. The immediate risks of shunting are related specifically to the patient's age, anesthesia and subsequent cardiovascular and pulmonary problems. Over the long term, shunts can malfunction -- causing and resulting in infection and/or blockage -- and may have to be revised or replaced.
Shunts are not a cure, but they can be a very effective way to treat NPH. It is difficult to predict if a patient will benefit from a shunt. Because of this, the decision to shunt is a critical one. CSF diversion with a shunt may first improve the patient's gait abnormality and second the urinary incontinence. It unfortunately may not be a remedy for the associated dementia.
NPH can be effectively managed by a neurologist to improve the quality of life for an individual.
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