Normal Pressure Hydrocephalus Symptoms & Causes
- Secondary hydrocephalus – Common causes of secondary hydrocephalus are a brain tumor, hemorrhage, infection or a trauma, such as falling down and hitting your head.
- Idiopathic hydrocephalus – Some people in their 60s, 70s and 80s develop hydrocephalus without any known cause, or idiopathic. In such patients, the pressure increase may be very mild and not always detectable, a condition known as normal pressure hydrocephalus (NPH).
Normal Pressure Hydrocephalus Causes
- Mental confusion – Mild forgetfulness, short-term memory loss, loss of interest in normal activities are often seen in people with NPH.
- Gait disturbance – Difficulty in walking can take many forms, such as taking small shuffling steps, a tendency to fall, a feeling that your feet are too heavy or difficulty climbing stairs.
- Urinary incontinence – Impaired bladder control consists of difficulty in holding back urine.
Normal pressure hydrocephalus may be difficult to diagnose, since not all of the symptoms may appear at the same time. Sometimes these same symptoms of normal pressure hydrocephalus are found in other disorders of the elderly, such as Alzheimer’s disease, Parkinson’s disease and osteoarthritis. There is no single test that establishes the diagnosis of NPH. The usual series of tests that are commonly used for this purpose include the following:
- Patient history and examination – is the basis of establishing the clinical diagnosis.
- CT scan (Computerized Tomography) of the head – A CT scan is often done as the first test, but may not be needed if an MRI has been obtained. The scan shows enlargement of the ventricles, or cavities, and is helpful in ruling out other specific causes for the hydrocephalus.
- MRI (Magnetic Resonance Imaging) – An MRI is more sensitive to abnormalities of the brain tissue and is a key component of the diagnostic work-up.
- Neuropsychological testing – A thorough neurological evaluation will be done by a trained neuropsychologist and can be helpful in getting a clearer picture of the type and severity of mental impairment. It can also help in following the course of a patient’s disease.
- Gait testing – This computerized measure helps in quantifying a patient’s gait (walking) impairment and is also helpful in documenting improvement with treatment.
- Spinal tap or lumbar puncture (LP) – A very fine-gauge needle is placed into the spinal canal, and the pressure of the cerebrospinal fluid is measured. At this time, the CSF is also examined for any other abnormal findings.
- Lumbar CSF drainage – A catheter is often inserted into the spine in the lower back for continuous drainage of cerebrospinal fluid over a three-day period. This procedure is more sensitive to improvement than a lumbar puncture alone.
- Intracranial pressure monitoring – This is sometimes used in cases where the diagnosis is unclear and actual monitoring of the pressure inside the head is thought to be necessary.