Normal pressure hydrocephalus is a buildup of cerebrospinal fluid in the brain ventricles in older adults, while opening pressure stays near normal. It is one of the few treatable causes of dementia, so it is worth recognizing early.
Key symptoms
- Walking problems: slow, short, shuffling steps
- Memory loss and slowed thinking
- Urinary urgency or incontinence
- Frequent falls
What you find on exam
- Magnetic gait: feet seem stuck to the floor, wide base
- Trouble turning, needing several steps
- Cognitive screen for attention and slowness
- No major focal weakness
Tests
- CT or MRI brain: large ventricles out of proportion to brain shrinkage
- Large-volume lumbar tap test with gait timed before and after
- Rule out other causes: vitamin B12, thyroid, medicines
Treatment basics
- Ventriculoperitoneal shunt for patients who improve after the tap test
- Physical therapy and fall prevention
- Bladder management and scheduled toileting
Red flags
- After a shunt: headache, vomiting or drowsiness from shunt failure
- Fever or redness along the shunt suggesting infection
- Rapid decline in walking or thinking
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.