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
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
More Guidelines- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer