Summary
Definition
History and exam
Key diagnostic factors
- levodopa-unresponsive gait apraxia
Other diagnostic factors
- cognitive impairment
- urinary frequency, urgency, or incontinence
- fecal 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
- continuous intracranial pressure monitoring
Treatment algorithm
suitable for surgery
not suitable for surgery
Contributors
Authors
Richard Adam Grünewald, MA, DPhil, FRCP

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 Mr 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.
Differentials
- Parkinson disease
- Parkinson-plus syndromes
- Cerebrovascular parkinsonism
More DifferentialsGuidelines
- Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response
- Guidelines for the diagnosis and management of idiopathic normal-pressure hydrocephalus
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