Normal Pressure Hydrocephalus (NPH)

People who experience one or more of the main symptoms of NPH should consult a neurosurgeon as soon as possible.

Before treatment can be discussed, your doctor may do the following as part of an NPH diagnosis:

• Review your medical history and perform a physical examination.
• Complete neurological and diagnostic testing via CT or MRI
• Conduct a spinal tap

The neurological examination will determine the severity of the condition by performing a series of diagnostic tests:

• CT or CAT scan (Computed tomography scan). This imaging scan produces a computer-generated image that shows if the ventricles are blocked or enlarged.
• MRI (Magnetic resonance imaging). This diagnostic test produces three-dimensional brain images using magnetic fields and computerized technology. It can detect if the flow of CSF is disrupted or if the ventricles are enlarged. This is the preferred test neurologists use for normal pressure hydrocephalus since it provides more information than the CAT scan.
• Lumbar puncture (spinal tap). Doctors will remove up to 50 cc of CSF. Some patients receive temporary relief from this procedure. The fluid is then analyzed, and the CSF pressure is measured. If removal of some CSF dramatically improves symptoms, even temporarily, then surgical treatment is a viable option. A limitation of lumbar puncture is that some people may have little or no improvement after the test. When the response to a lumbar puncture is “negative” or uncertain, further evaluation may be helpful.
• Lumbar drain trial: Like the lumbar puncture, CSF will be removed to determine if it improves symptoms. This requires a 4 day hospital admission. A thin, flexible tube, called a catheter, is inserted in your spine under x-ray guidance. CSF will be intermittently drained via the catheter during your hospital stay. This test is helpful for predicting the outcome after ventricular shunting in patients.