Normal Pressure Hydrocephalus (NPH)

What is normal pressure hydrocephalus?

Normal pressure hydrocephalus (NPH) is a treatable condition of the brain that usually affects people 60 years of age and older.

Our bodies regularly produce spinal fluid in the brain. However, as we age, this fluid will not always get reabsorbed at the same rate. NPH is a condition of the brain where cerebrospinal fluid (CSF) builds up in the brain’s ventricles and causes pressure. The ventricles then push out against the brain which can stretch the brain and neurons that control balance, bladder, memory and thought processes.

NPH: not just “normal aging”

NPH is frequently underdiagnosed because many often attribute the common symptoms to "normal aging." Possible symptoms of NPH include:

• Trouble walking or changes to walking patterns
• Poor balance
• Falling
• Forgetfulness
• Mood changes
• Depression
• Difficulty responding to questions
• Loss of bladder or bowel control

Because many of these symptoms are similar to those of dementia, patients are misdiagnosed and left untreated or are improperly treated. However, unlike dementia, NPH is treatable with surgery. A visit to a specialist could lead to proper diagnosis and treatment. For some, the surgical procedure can stop and even reverse the symptoms. Many patients may even return to independent living and enjoying their daily activities.

A multidisciplinary approach to a complex condition

The accurate diagnosis of NPH requires a multidisciplinary team and approach. It’s a far cry from a simple scan or blood test. By drawing on the expertise of a number of different specialists, we can guide our patients to the correct diagnosis and most effective treatment.

At Inova, our multidisciplinary team of experts including neurosurgeons, neurologists, physical therapists, occupational therapists, speech therapists, radiologists, and clinical nurses are dedicated to the diagnosis and treatment of NPH. We are one of just a few centers that uses a collaborative approach to diagnose this condition.

Diagnosing and treating NPH

The most accurate means of diagnosing this condition requires a 3-day hospital stay where our skilled medical team will perform a lumbar drainage. Or, in simple terms, we will drain fluid from the lower back. This process is essential because it simulates the effects of the surgical treatment for NPH.

During these three days, the team will analyze the results of the lumbar drainage:

• If the symptoms improve after the three-day drainage, we can predict the surgery will be beneficial. We then place a small, programmable shunt (tubing) using small incisions in the scalp and abdomen to provide continual drainage. This will prevent CSF buildup and the subsequent brain pressure. Thanks to advances in technology, this programmable device will allow us to make any necessary adjustments using external magnets as needed; a separate surgery would not be required.
• If the symptoms do not improve after the drainage, this, too, gives us valuable information. It means we can rule out NPH as the cause of the symptoms. We can then refer those patients to more specialized testing to identify their condition and develop a treatment plan.

When should I call my healthcare provider?

If you or an elderly loved one have experienced changes in walking, thinking, mood, and/or loss of bowel and bladder control, contact Inova's Memory Program for a consult at 703-776-4700.

Blog post about NPH

Learn more about Normal Pressure Hydrocephalus (NPH)