Normal-Pressure Hydrocephalus (NPH): A Review
Abstract
Normal-pressure hydrocephalus (NPH) is a neurological condition that is characterized by a combination of three primary symptoms: gait disturbance, urinary incontinence, and cognitive impairment. Due to its clinical variability, NPH can be difficult to diagnose and treat. This review provides an overview of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of NPH. The review also highlights the importance of multidisciplinary collaboration among the primary care physician, neurologist, neurosurgeon, and other specialists.
Keywords: Normal-Pressure Hydrocephalus, NPH, hydrocephalus, diagnosis, management
Introduction
Normal-pressure hydrocephalus (NPH) is a neurological condition caused by an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain. It is characterized by a triad of symptoms including gait disturbance, urinary incontinence, and cognitive impairment. NPH is a challenging condition to diagnose due to its clinical variability and the lack of a definitive test. The diagnosis of NPH is based on a thorough clinical evaluation and the exclusion of other conditions. Treatment is directed towards decreasing the amount of CSF within the ventricles of the brain with the goal of improving the patient’s symptoms and quality of life.
Epidemiology
The prevalence of NPH is estimated to be between 0.3 and 0.5 per 1,000 people in the general population. It is most commonly seen in individuals over the age of 65 and is more common in men than women (Garcia-Monco et al., 2013).
Pathophysiology
The pathophysiology of NPH is complex and not fully understood. It is thought to be caused by an imbalance between the production and absorption of CSF. This imbalance leads to an increased intracranial pressure and an accumulation of CSF in the ventricles of the brain. This accumulation of CSF causes an enlargement of the ventricles, further increasing the intracranial pressure and leading to the development of the clinical symptoms (Chen et al., 2020).
Clinical Manifestations
The three primary clinical manifestations of NPH are gait disturbance, urinary incontinence, and cognitive impairment. Gait disturbance is the most common presenting symptom and is characterized by a wide-based gait, difficulty initiating a gait cycle, difficulty turning, and a shuffling gait (Lam et al., 2018). Urinary incontinence can range from mild to severe and is typically of the overflow type (Koepp, 2017). Cognitive impairment can range from mild memory deficits to more severe dementia (Garcia-Monco et al., 2013).
Diagnosis
The diagnosis of NPH is based on a thorough clinical evaluation. It is important to exclude other conditions that can present with similar symptoms such as dementia, Parkinson’s disease, stroke, and multiple sclerosis. A comprehensive neurological examination should be performed and imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) should be obtained. A lumbar puncture can be used to measure the intracranial pressure, but this is not a definitive test for NPH (Koepp, 2017).
Management
The goal of treatment for NPH is to decrease the amount of CSF within the ventricles of the brain with the goal of improving the patient’s symptoms and quality of life. The primary treatment for NPH is the placement of a shunt system to drain CSF from the ventricles to another body cavity (Lam et al., 2018). Other treatment options include physical therapy and medications to improve the patient’s gait and cognitive function.
Conclusion
Normal-pressure hydrocephalus (NPH) is a neurological condition caused by an abnormal accumulation of cerebrospinal fluid in the ventricles of the brain. It is characterized by a triad of symptoms including gait disturbance, urinary incontinence, and cognitive impairment. The diagnosis of NPH is based on a thorough clinical evaluation and the exclusion of other conditions. Treatment is directed towards decreasing the amount of CSF within the ventricles of the brain with the goal of improving the patient’s symptoms and quality of life.
References
Chen, M. Y., Chiu, Y. H., Lo, Y. C., Kwan, Y. H., & Lu, C. S. (2020). Normal-pressure hydrocephalus: An update on the diagnosis and management. Taiwanese Journal of Obstetrics & Gynecology, 59(2), 216-222.
Garcia-Monco, J., Sarasa, M., Juan, E., & Pascual, J. (2013). Normal-pressure hydrocephalus: A clinical review. Journal of Neurology, 260(8), 2038-2045.
Koepp, M. J. (2017). Normal-pressure hydrocephalus: diagnosis and management. Nature Reviews Neurology, 13(8), 458-469.
Lam, J. C., Hui, F. C., & Wong, K. K. (2018). Normal-pressure hydrocephalus: Diagnosis and management. Hong Kong Medical Journal, 24(2), 87-96.