Normal pressure hydrocephalus

Last reviewed: 22 Apr 2022
Last updated: 17 Oct 2019

Summary

Definition

History and exam

Key diagnostic factors

  • levodopa-unresponsive gait apraxia
More key diagnostic factors

Other diagnostic factors

  • cognitive impairment
  • urinary frequency, urgency, or incontinence
  • faecal incontinence
Other diagnostic factors

Risk factors

  • age >65 years
  • vascular disease
  • diabetes mellitus
More risk factors

Diagnostic investigations

1st investigations to order

  • CT head (without contrast) or MRI head
  • levodopa challenge
More 1st investigations to order

Investigations to consider

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

Treatment algorithm

ONGOING

suitable for surgery

not suitable for surgery

Contributors

Authors

Richard Adam Grünewald, MA, DPhil, FRCP
Richard Adam Grünewald

Consultant Neurologist

Honorary Clinical Senior Lecturer

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield

UK

Disclosures

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.

Acknowledgements

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

Peer reviewers

Robin Wilson, MD, PhD

Associate Director

Adult Hydrocephalus Center

Sandra and Malcolm Berman Brain & Spine Institute

Sinai Hospital

Baltimore

MD

Disclosures

RW declares that she has no competing interests.

  • Normal pressure hydrocephalus images
  • Differentials

    • Parkinson's disease
    • Parkinson's-plus syndromes
    • Cerebrovascular parkinsonism
    More Differentials
  • Guidelines

    • Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response
    • Guidelines for management of idiopathic normal pressure hydrocephalus: second edition
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer