Last reviewed:September 2019
Last updated:October  2019

Summary

Definition

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
Full details

Investigations to consider

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

Treatment algorithm

Contributors

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.

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

Baltimore

MD

Disclosures

RW declares that she has no competing interests.

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