NPH (normal pressure hydrocephalus)

Normal pressure hydrocephalus (NPH) is a chronic type of communicating hydrocephalus whereby the increase in intracranial pressure (ICP) due to accumulation of cerebrospinal fluid (CSF) becomes stable and that the formation of CSF equilibrates with absorption. The ICP gradually falls but still maintains a slightly elevated level and the CSF pressure reaches a high normal level of 150 to 200 mmH2O. Measurements of CSF pressure, therefore are ususally normal. Because of this equilibration, patients do not exhibit the classic signs of increased intracranial pressure such as headache, nausea, vomiting, or altered consciousness. (Though some studies have shown pressure elevations to occur only intermittently). However, patients do exhibit the classic triad of gait difficulties, urinary incontinence, and mental decline. It is often misdiagnosed as Parkinson's disease, Alzheimer's disease, and senility due to its chronic nature and its presenting symptoms. And, although the exact mechanism is unknown, normal-pressure hydrocephalus is thought to be a form of communicating hydrocephalus with impaired CSF reabsorption at the arachnoid villi.

NPH may be relieved by surgically implanting a ventriculoperitoneal shunt to drain excess cerebrospinal fluid to the abdomen where it is absorbed. Once the shunt is in place, the ventricles often diminish in size in 3 to 4 days, regardless of the duration of the hydrocephalus. Most patients who have continued success with such shunts usually only have two of the three triads (excluding incontinence).