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Normal Pressure Hydrocephalus


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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

  1. 1. 42 Park Road Peterborough PE1 2UQ 01733 555988Normal Pressure HydrocephalusHydrocephalus is perceived as a condition affecting babiesand children. Normal pressure hydrocephalus (NPH) usuallyoccurs in the sixth and seventh decade of life.What is NPH? subarachnoid haemorrhage or infection such as meningitis.Normal pressure hydrocephalusis an abnormal accumulation of What are the symptoms?cerebrospinal fluid (CSF) in theventricles (cavities) of the brain with There are three symptoms commonlittle or no increase in pressure. to everyone diagnosed with NPH.Under normal conditions, about a These are:pint of CSF is produced daily in theadult brain. This circulates through gait disturbance the ventricles and the brain and urinary incontinence spinal cord carrying nutrients to dementiathe brain and acting as a buffer toprevent injury. 1. Gait (walking) disturbanceNPH results when the flow of CSF This is usually the first symptom thatis blocked in some way. people notice. Although there is no “classical” pattern, some peopleWhat causes NPH? develop a wide based walk whilst others take small shuffling steps.In most people, the cause isunknown: in others it can be They may have poor balance andsecondary to head injury or have frequent falls.
  2. 2. Normal Pressure Hydrocephalus2. Urinary incontinence Computerised tomography (CT) or magnetic resonance imagingUsually starts as frequency and/or (MRI) of the brain will show dilatedurgency. But, incontinence may be (enlarged) ventricles in NPH anddue to walking difficulties (unable to the clinical assessment will includereach the toilet in time) or normal lumbar puncture which will showconsequence of age i.e. prostate normal or near normal pressure.problems. Can NPH be treated?3. Dementia At lumbar puncture some 30mlDementia is usually mild, of CSF will be withdrawn. Thoseprogressing to moderate and patients whose symptoms improvewill include short term memory after lumbar puncture are thoseloss, forgetfulness and difficulty in likely to benefit from surgery. Atdealing with everyday tasks. operation, a shunt (fine tube) is inserted into one of the ventricles inBecause these symptoms are of the brain so as to drain the excessgradual onset and are commonly CSF and reroute it to another partassociated with increasing age, of the body (usually the abdomen).many people think that this is the The shunt is under the skin and isnorm and assume that they must permanent: by this method NPHlearn to live with their problems. can be controlled.Even GPs and other medicalprofessionals may not initially How successful is theconsider a diagnosis of NPH when shunt operation?presented with a patient with thistriad 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 likelyto be the GP who should considerreferral to a neurologist or neuro-surgeon.
  3. 3. Will I know if the shunt is not SHUNT ALERT CARDSworking properly? Shine has a series of Shunt AlertOnset of headaches may mean that Cards, for adults and children.the shunt is overdraining. This can be These should be carried at all timesminimised by the surgeon using an by people with hydrocephalusadjustable shunt so that the doctor treated by a shunt (this will includecan alter the pressure without further some people with spina bifida)surgery. People with NPH may needfrequent 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 thewalking problems will usually be cardholder is showing signs similarthe first symptoms to re-occur. The to those which occur when there isneurosurgeon needs to be informed shunt blockage or infection, urgentas this may mean that the shunt has assessment of shunt functionmalfunctioned. should be carried out in a specialist neuro-surgical unit, in order toFurther information eliminate shunt failure as a cause.For further information on Normal People applying for a ShuntPressure Hydrocephalus please Alert Card can also requestcontact Shine on 01733 555988 to that an information sheet aboutspeak 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. 4. Help usShine relies on people’s generosity and support so we can help our clientswho depend on us for help and advice - people with hydrocephalus,spina bifida, their families and carers. To donate to Shine please or call 01733 421329.This information has been produced by Shine’s medical advisers andapproved by Shine’s Medical Advisory Committee of senior medicalprofessionals.Shine - Registered charity no.249338To see our full range of information sheets and to find out how to donateto Shine please visit