Normal pressure hydrocephalus (NPH) is a condition in which excess cerebrospinal fluid (CSF) accumulates in the brain's ventricles, which causes them to expand and press on the surrounding brain tissue. There are many reasons why PHN is misdiagnosed as Alzheimer's disease, Parkinson's disease, or aging-related decline. PHN usually affects older adults and can affect walking, thinking, and bladder control. It is important to note, however, that NPH can sometimes be treated and reversed with appropriate intervention, unlike these conditions.
Causes
NPH is thought to result from an imbalance between CSF production and absorption, the clear fluid that surrounds and protects the brain and spinal cord. Normally, CSF flows through the ventricles and exits into the space around the brain, where it is reabsorbed into the blood vessels. However, in NPH, the CSF flow or absorption is impaired, resulting in the buildup of fluid in the ventricles. Due to the increased fluid volume, the ventricles expand and compress the brain tissue, affecting its function.
The following factors may increase the risk of developing NPH:
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Trauma or injury to the head
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Inflammation or infection of the brain
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Radiation or surgery on the brain
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Brain bleeding
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Brain aging or degeneration
Symptoms
According to the severity and location of the ventricular enlargement and brain compression, NPH can cause a variety of symptoms. The most common symptoms include:
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NPH is characterized by gait disturbance, which is characterized by difficulty walking, maintaining balance, or coordinating movements. A person with NPH may have a slow, shuffling, or unsteady gait, and may feel as if their feet are stuck on the ground. The patient may also fall frequently or have difficulty turning or climbing stairs.
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It refers to problems with memory, attention, reasoning, or problem-solving. People with NPH may have difficulty recalling recent events, following instructions, or finding words. They may also experience confusion, disorientation, or personality changes.
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An individual with urinary incontinence may have difficulty starting or stopping urination, or may have sudden or frequent urges to urinate. They also might have nocturia, or the need to urinate at night.
Diagnosis
The diagnosis of NPH can be difficult, as the symptoms can mimic other conditions or be attributed to normal aging. A doctor will perform a comprehensive medical history and physical examination in order to diagnose NPH, and ask about the symptoms' onset, duration, and progression. In addition to measuring the pressure and volume of CSF in the brain, the doctor will also order tests to rule out other possible causes. Some of the tests used to diagnose NPH include:
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MRIs and CT scans can show the size and shape of the ventricles and the brain tissue, as well as detect any abnormalities or lesions that may affect CSF absorption or flow.
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A lumbar puncture is a procedure in which a needle is inserted into the lower back to get some CSF for analysis. By temporarily reducing the CSF volume in the brain, it can relieve some of the symptoms of NPH and help measure the pressure and composition of the CSF.
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Infusion tests are performed by inserting a catheter into the lower back to inject fluid into the CSF space to measure the brain's ability to absorb excess fluid and predict how it will respond to treatment.
Treatment
The main treatment option for NPH is to reduce the CSF volume in the brain and relieve its symptoms.
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During shunt surgery, a device called a shunt is implanted in the brain to divert excess CSF from the ventricles to a place in the body where it can be absorbed, such as the abdomen or heart. There is a catheter, a valve, and a reservoir in the shunt, which can be adjusted to control how much and where CSF flows. In about 80% of cases, shunt surgery can improve symptoms of NPH, but it carries some risks and complications, including infection, bleeding, malfunction, or overdraining.
NPH can also be treated with the following options:
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The use of medications can manage some of the symptoms or associated conditions of NPH, such as pain, infection, or depression. However, medications cannot treat the underlying cause of NPH or reverse the brain damage.
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Besides improving gait, balance, and mobility, physical therapy can also strengthen muscles, joints, and bones, as well as improve overall fitness and well-being.
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A cognitive therapy can improve the person's memory, attention and problem-solving skills, as well as provide strategies to cope with the cognitive impairment. It can also improve their mood, self-esteem, and social interaction.
Prevention
As NPH is caused by genetic or environmental factors that are not fully understood or controlled, there are no known ways to prevent it. However, there are some possible ways to reduce the severity or risk of NPH.
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Smoking, alcohol, or drug use can damage the brain and affect CSF production and absorption.
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Any head injury, brain infection, or bleeding that can cause or worsen NPH should be treated promptly.
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Preventing or delaying age-related or degenerative brain changes by maintaining a healthy weight, blood pressure, and cholesterol level.
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By getting regular checkups and screenings for NPH, especially if at high risk or experiencing symptoms, you can detect and treat NPH early and prevent further brain damage.
