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Normal pressure hydrocephalus

Last reviewed: 1 Nov 2024
Last updated: 31 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • levodopa-unresponsive gait apraxia
Full details

Other diagnostic factors

  • cognitive impairment
  • urinary frequency, urgency, or incontinence
  • fecal incontinence
Full details

Risk factors

  • age >65 years
  • vascular disease
  • diabetes mellitus
Full details

Diagnostic tests

1st tests to order

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

Tests 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

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.

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  • Guidelines

    • 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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