This article is on the facebook page of the NPH Support Group (Normal Pressure Hydrocephalus)
The author is not known but it is a very useful overview of the symptoms, treatment and care required for NPH.
As an additional note from all that I have read no two people have identical symptoms and no two people have the same response to and recovery from surgery.
Even four months after surgery I still feel as though someone has slapped my head around the area where the shunt is implanted.
Also worth noting that shunt surgery is not a cure. NPH never goes away. But the shunt is a solution that replaces a critical function that your body can no longer perform.
This is the article from the NPH support group:
Normal pressure hydrocephalus (NPH) is a condition that happens when you have too much of a certain kind of fluid in parts of your brain.
Your brain and spinal cord are surrounded by a clear liquid called cerebrospinal fluid (CSF). It’s made and stored in cavities in your brain called ventricles. It circulates around your brain, moving from ventricle to ventricle. It cushions and protects the brain and spinal cord, supplies them with nutrients, and removes some of their waste products. Extra fluid usually drains away from the brain and is absorbed by veins at the top of the brain.
Hydrocephalus happens when the natural system for draining and absorbing extra CSF doesn’t work right. The ventricles enlarge to accommodate the extra fluid and then press on different parts of the brain, causing a number of different symptoms. Hydrocephalus has many different causes. Some people are born with the condition, while others develop it during their lives.
Normal pressure hydrocephalus (NPH) is a type of hydrocephalus that usually happens in older adults. The average age of a person with NPH is over age 60. NPH is different from other types of hydrocephalus in that it develops slowly over time. The drainage of CSF is blocked gradually, and the extra fluid builds up slowly. It causes the ventricles to enlarge slowly and the fluid pressure in the brain may not be as high as in other types of hydrocephalus. However, the enlarged ventricles still press on the brain and can cause symptoms (the term “normal pressure” is somewhat misleading).
The parts of the brain most often affected in NPH are those that control the legs, the bladder, and the “cognitive” mental processes such as memory, reasoning, problem solving, and speaking. This decline in mental processes, if it is severe enough to interfere with everyday activities, is known as dementia. Other symptoms include abnormal gait (difficulty walking), inability to hold urine (urinary incontinence), and, occasionally, inability to control the bowels.
The dementia symptoms of NPH can be similar to those of Alzheimer’s disease. The walking problems are similar to those of Parkinson’s disease. Experts say that many cases of NPH are misdiagnosed as one of these diseases. Unlike Alzheimer’s and Parkinson’s, NPH can be reversed in many people with appropriate treatment. But first it must be correctly diagnosed
Normal Pressure Hydrocephalus Causes
In most cases, the cause of NPH isn’t known, but several things can lead to
A head injury
Bleeding around the brain (due to a blow to the head)
Meningitis (infection of a protective layer of tissue around the brain)
Brain tumor
Surgery on the brain
How these conditions lead to NPH is not clear.
Normal Pressure Hydrocephalus Symptoms
At first, the symptoms of normal pressure hydrocephalus are usually very subtle. They worsen very gradually.
Symptoms of dementia include:
Memory loss
Speech problems
Apathy (indifference) and withdrawal
Changes in behavior or mood
Difficulties with reasoning, paying attention, or judgment
Walking problems
Unsteadiness
Leg weakness
Sudden falls
Shuffling steps
Difficulty taking the first step, as if feet were stuck to the floor
Getting stuck” or “freezing” while walking
Urinary symptoms:
Inability to hold urine
Inability to hold stool, or feces (less common)
Frequent urination
Urgency to urinate
At any point in this process, your health care provider may refer you to a specialist in brain disorders (neurologist or neurosurgeon) to complete the evaluation and begin treatment.
The evaluation begins with a medical interview, when your doctor will ask about:
Your symptoms and when they started
Your medical and mental problems now and in the past
Your family’s medical problems
Medications you have taken now and in the past
Your work and travel experiences
Your habits and lifestyle
Then they’ll do a detailed physical exam to document your condition and rule out other disorders that might cause similar symptoms. The exam will probably include:
Surgery for normal pressure hydrocephalus
Normal pressure hydrocephalus is not caused by any structural abnormality, such as a brain tumor.
In most cases, the underlying problem is not known or cannot be treated. The treatment in these cases is a shunt operation.
A shunt is a thin tube that is implanted in the brain by a neurosurgeon. It is inserted into the ventricles to drain excess CSF away from the brain. The tube is routed under the skin from the head to another part of the body, usually the peritoneum (the lower belly). The shunt is equipped with a valve that opens to release fluid when the pressure builds up. The fluid drains harmlessly and is later absorbed by the bloodstream. The pressure setting on the valve sometimes must be readjusted. The newer shunts allow adjustment without another operation.
A shunt operation is not a cure. It does not treat the underlying cause of NPH. It can, however, relieve the symptoms. The shunt remains in place indefinitely. If properly implanted, the shunt often is not obvious to other people.
Shunt operations do not work for everyone with NPH. Many people who undergo a shunt operation have substantial symptom relief. In some, the symptoms improve and then start to worsen again.
Others benefit little, if at all. Even the experts are not able to predict perfectly who will benefit and who will not. Many surgeons perform a spinal tap before surgery to test whether the symptoms get better with removal of fluid. In some cases, the person is hospitalized for a few days while fluid is drained slowly through a small tube called a catheter. This is another way of checking whether removing extra fluid will help symptoms.
The earlier the NPH is diagnosed, the better the chances that the surgery will help. In general, people with milder symptoms have better outcomes with this surgery. Like any surgery, the shunt operation can cause complications. Such complications include infection of the shunt and blood clots around the brain. Your neurologist or neurosurgeon will discuss the pros and cons of this operation and whether it might work for you.
Another operation is sometimes used instead of shunt placement. In endoscopic third ventriculostomy, an endoscope (thin tube with a lighted camera on the end) is used to create a small hole in the floor of the ventricles. The hole provides another way for CSF to drain from the brain.
Caring for someone with normal pressure hydrocephalus
An individual with normal pressure hydrocephalus should always be under the care of a medical professional. Much of the day-to-day care, however, is handled by family and caregivers. Medical care should focus on optimizing the individual’s health, safety, and quality of life while helping family members cope with the many challenges of caring for a loved one with dementia and other symptoms of NPH.
The degree of care required by people with NPH varies considerably. Those who undergo successful shunt surgery may continue to live a normal or near-normal independent life. Others will have worsening of their symptoms over time. Many of these individuals will eventually require close supervision and care. Your neurologist or neurosurgeon should discuss with you and your family what to expect as time goes on.
It’s important to know that no drug or other medical treatment is known to work in NPH.
This is another, more detailed, read:
Review of the Treatment & Management of Hydrocephalus
Jacqueline Groat, PharmD Candidate
Washington State University College of Pharmacy
Spokane, Washington
Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor of Pharmacotherapy
Washington State University College of Pharmacy
Spokane, Washington