Normal pressure hydrocephalus (NPH) is a chronic communicating hydrocephalus. The patient shows symptomatic hydrocephalus without clinical evidence of intracranial hypertension. Bret et al believe the term "chronic hydrocephalus" may more accurately reflect the condition.


Onset: originally described in adults, it may occur in any age after infancy


Classic clinical triad:

(1) mental impairment, often confused with Alzheimer's disease or other dementia in the elderly but which may be subtle in a younger person

(2) gait disturbance (repeating falling, shuffling gait, other)

(3) incontinence secondary to sphincter disturbances (urinary incontinence in children may be mistaken for enuresis)


Findings seen with intracranial hypertension (headache, vomiting, papilledema) are typically absent because of the obstruction to the CSF is extremely gradual.


The opening pressure on lumbar puncture is normal. However, if continuous monitoring is performed then periodic elevations in pressure may be detected. Also the intracranial pressure may be higher than that indicated by the lumbar pressure.


Imaging studies show hydrocephalus with ventricular dilatation.


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