Normal pressure hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles (cavities) of the brain with little or no increase in pressure.

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Normal Pressure Hydrocephalus
Hydrocephalus is perceived as a condition affecting babies
and children. Normal pressure hydrocephalus (NPH) usually
occurs in the sixth and seventh decade of life.
What is NPH? subarachnoid haemorrhage or
infection such as meningitis.
Normal pressure hydrocephalus
is an abnormal accumulation of What are the symptoms?
cerebrospinal fluid (CSF) in the
ventricles (cavities) of the brain with There are three symptoms common
little or no increase in pressure. to everyone diagnosed with NPH.
Under normal conditions, about a These are:
pint of CSF is produced daily in the
adult brain. This circulates through gait disturbance
the ventricles and the brain and urinary incontinence
spinal cord carrying nutrients to dementia
the brain and acting as a buffer to
prevent injury. 1. Gait (walking) disturbance
NPH results when the flow of CSF This is usually the first symptom that
is blocked in some way. people notice. Although there is no
“classical” pattern, some people
What causes NPH? develop a wide based walk whilst
others take small shuffling steps.
In most people, the cause is
unknown: in others it can be They may have poor balance and
secondary to head injury or have frequent falls.

2. Normal Pressure Hydrocephalus
2. Urinary incontinence Computerised tomography (CT)
or magnetic resonance imaging
Usually starts as frequency and/or (MRI) of the brain will show dilated
urgency. But, incontinence may be (enlarged) ventricles in NPH and
due to walking difficulties (unable to the clinical assessment will include
reach the toilet in time) or normal lumbar puncture which will show
consequence of age i.e. prostate normal or near normal pressure.
problems.
Can NPH be treated?
3. Dementia
At lumbar puncture some 30ml
Dementia is usually mild, of CSF will be withdrawn. Those
progressing to moderate and patients whose symptoms improve
will include short term memory after lumbar puncture are those
loss, forgetfulness and difficulty in likely to benefit from surgery. At
dealing with everyday tasks. operation, a shunt (fine tube) is
inserted into one of the ventricles in
Because these symptoms are of the brain so as to drain the excess
gradual onset and are commonly CSF and reroute it to another part
associated with increasing age, of the body (usually the abdomen).
many people think that this is the The shunt is under the skin and is
norm and assume that they must permanent: by this method NPH
learn to live with their problems. can be controlled.
Even GPs and other medical
professionals may not initially How successful is the
consider a diagnosis of NPH when shunt operation?
presented with a patient with this
triad of symptoms. Advances in shunt technology
mean that today’s treatment will,
How is NPH diagnosed? in the majority of cases, mean an
improvement in symptoms.
The initial point of contact is likely
to be the GP who should consider
referral to a neurologist or
neuro-surgeon.

3. Will I know if the shunt is not SHUNT ALERT CARDS
working properly?
Shine has a series of Shunt Alert
Onset of headaches may mean that Cards, for adults and children.
the shunt is overdraining. This can be These should be carried at all times
minimised by the surgeon using an by people with hydrocephalus
adjustable shunt so that the doctor treated by a shunt (this will include
can alter the pressure without further some people with spina bifida)
surgery. People with NPH may need
frequent adjustments in the early The cards are available from Shine,
months. Telephone 01733 555988.
If the shunt is under-draining, the The card emphasises that, if the
walking problems will usually be cardholder is showing signs similar
the first symptoms to re-occur. The to those which occur when there is
neurosurgeon needs to be informed shunt blockage or infection, urgent
as this may mean that the shunt has assessment of shunt function
malfunctioned. should be carried out in a specialist
neuro-surgical unit, in order to
Further information eliminate shunt failure as a cause.
For further information on Normal People applying for a Shunt
Pressure Hydrocephalus please Alert Card can also request
contact Shine on 01733 555988 to that an information sheet about
speak to a Specialist Adviser hydrocephalus, specially written for
doctors, is sent to their GP.
Teachers and employers can ask
for “Shunt malfunctions: a guide to
symptoms and suggested actions
for schools/employers”.

4. Help us
Shine relies on people’s generosity and support so we can help our clients
who depend on us for help and advice - people with hydrocephalus,
spina bifida, their families and carers. To donate to Shine please visit
www.shinecharity.org.uk or call 01733 421329.
This information has been produced by Shine’s medical advisers and
approved by Shine’s Medical Advisory Committee of senior medical
professionals.
Shine - Registered charity no.249338
To see our full range of information sheets and to find out how to donate
to Shine please visit www.shinecharity.org.uk