Last reviewed: 13 May 2021
Last updated: 17 Oct 2019



History and exam

Key diagnostic factors

  • levodopa-unresponsive gait apraxia

Other diagnostic factors

  • cognitive impairment
  • urinary frequency, urgency, or incontinence
  • faecal incontinence

Risk factors

  • age >65 years
  • vascular disease
  • diabetes mellitus

Diagnostic investigations

1st investigations to order

  • CT head (without contrast) or MRI head
  • levodopa challenge

Investigations to consider

  • lumbar puncture
  • lumbar puncture with large-volume cerebrospinal fluid (CSF) tap
  • prolonged external lumbar drainage
  • cerebrospinal fluid (CSF) infusion procedure

Treatment algorithm


Richard Adam Grünewald

Consultant Neurologist

Honorary Clinical Senior Lecturer

Sheffield Teaching Hospitals NHS Foundation Trust




RAG has chaired a NICE guideline development group on neurological conditions, including recognition of movement disorders associated with normal pressure hydrocephalus. RAG received standard remuneration for chairing a NICE guideline development group. RAG is the author of a paper cited in this topic.

Dr Richard Grünewald would like to gratefully acknowledge Dr Jeremy Rowe, a previous contributor to this topic.

Peer reviewersVIEW ALL

Associate Director

Adult Hydrocephalus Center

Sandra and Malcolm Berman Brain & Spine Institute

Sinai Hospital




RW declares that she has no competing interests.

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