Last reviewed: 23 Jun 2024
Last updated: 13 Oct 2022
Summary
Definition
History and exam
Key diagnostic factors
- levodopa-unresponsive gait apraxia
Full details
Other diagnostic factors
- cognitive impairment
- urinary frequency, urgency, or incontinence
- faecal incontinence
Full details
Risk factors
- age >65 years
- vascular disease
- diabetes mellitus
Full details
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
- continuous intracranial pressure monitoring
Full details
Treatment algorithm
ONGOING
suitable for surgery
not suitable for surgery
Contributors
Authors
Richard Adam Grünewald, MA, DPhil, FRCP
![Richard Adam Grünewald](/api/image/712/en-gb/normal/712-auth-1_default.jpg)
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's disease
- Parkinson's-plus syndromes
- Cerebrovascular parkinsonism
More DifferentialsGuidelines
- Guidelines for management of idiopathic normal pressure hydrocephalus: third edition
- Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response
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