| Normal-pressure hydrocephalus | |
|---|---|
| Other names | Malresorptive hydrocephalus, adult hydrocephalus syndrome[1] |
 | |
| Evan's index is the ratio of maximum width of the frontal horns to the maximum width of the inner table of the cranium. An Evan's index more than 0.31 indicates hydrocephalus.[2] | |
| Specialty | Neurology |
| Symptoms | Urinary incontinence, dementia, trouble walking[1] |
| Usual onset | Elderly[3] |
| Types | Primary, secondary[1] |
| Causes | Unknown, subarachnoid hemorrhage, head trauma, prior infection, tumor, complications of surgery[3] |
| Diagnostic method | Based on symptom, supported by medical imaging and improvement after lumbar puncture[1] |
| Differential diagnosis | Parkinson disease, Alzheimer disease[3] |
| Treatment | Surgery[3] |
| Prognosis | 80% improve post surgery[1] |
| Frequency | ~1.5% (> 65 years old)[1] |
Normal-pressure hydrocephalus (NPH) is build up of cerebrospinal fluid (CSF) in the ventricles, with near normal cerebrospinal fluid pressure.[4] Symptoms classically include urinary incontinence, dementia, and trouble walking.[1] The trouble walking often involves shuffling or a wide-based gait.[1] Urinary problems may begin as frequent urination.[1] Without treatment, symptoms worsen over time.[3]
While the cause is frequently unknown, it may also occur as a result of a subarachnoid hemorrhage, head trauma, prior infection, tumor, or complications of surgery.[3] The underlying mechanism is believed to involves insufficient absorption of CSF by the arachnoid granulations.[4] It is a type of communicating hydrocephalus.[1] The diagnosis is suspected based on symptom and may be further support by medical imaging and improvement of symptoms after lumbar puncture to drain CSF.[1] Conditions that may present similarly include Parkinson and Alzheimer disease.[3]
Treatment is by surgery to place a ventriculoperitoneal shunt to drain excess CSF into the abdomen to be absorbed by the lining.[3] In those who are unable to have surgery, repeated drainage by lumbar puncture and acetazolamide may be an option.[1] The probability of improvement following surgery is 80%.[1]
NPH most commonly occurs in the elderly.[3] One study found that it affects about 0.2% of those in their 70s and 5.9% of those over 80 years old.[1] Males and females are affected with similar frequency.[1] It is though to represent about 6% of cases of dementia.[1] The disease was first described by Salomón Hakim and Adams in 1965.[5][4]
References edit
- ^ a b c d e f g h i j k l m n o p M Das, J; Biagioni, MC (January 2021). "Normal Pressure Hydrocephalus". PMID 31194404.
{{cite journal}}: Cite journal requires|journal=(help) - ^ Ishii, Mitsuaki; Kawamata, Toshio; Akiguchi, Ichiro; Yagi, Hideo; Watanabe, Yuko; Watanabe, Toshiyuki; Mashimo, Hideaki (2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. ISSN 2042-0080. PMC 2951141. PMID 20948890.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ a b c d e f g h i "Normal Pressure Hydrocephalus Information Page | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Archived from the original on 1 March 2021. Retrieved 4 March 2021.
- ^ a b c Dening, Tom; Thomas, Alan; Taylor, John Paul; Stewart, Robert (2020). Oxford Textbook of Old Age Psychiatry. Oxford University Press. p. 527. ISBN 978-0-19-880729-2. Archived from the original on 2021-08-28. Retrieved 2021-03-04.
- ^ Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (July 1965). "Symptomatic Occult Hydrocephalus with Normal Cerebrospinal-Fluid Pressure". The New England Journal of Medicine. 273 (3): 117–26. doi:10.1056/NEJM196507152730301. PMID 14303656.