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Normal Pressure Hydrocephalus

What Are the Symptoms of Normal Pressure Hydrocephalus?

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

The following symptoms can be related to increased pressure in the brain:


When to Seek Medical Care for Normal Pressure Hydrocephalus

Some people think that memory loss, difficulty finding words, walking problems, or urination problems are normal parts of aging. In many cases, however, these are symptoms of treatable conditions. Any of these problems, or changes in mood or behavior, warrants a visit to your health care provider.

How Is Normal Pressure Hydrocephalus Diagnosed?

The symptoms of normal pressure hydrocephalus can also occur in Alzheimer's disease and Parkinson's disease. However, the combination of dementia-like symptoms, walking problems, and urinary problems should alert your health care provider to the possibility of NPH. Making the distinction is very important because the treatments for these conditions are quite different. Tests are available that can diagnose NPH. 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. The medical professional will ask you questions 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, and your habits and lifestyle. This is followed by a detailed physical exam to document your condition and rule out other disorders that might cause similar symptoms. The exam will probably include tests of your mental status, such as answering questions and following simple directions. Neuropsychological testing may be performed to document your dementia symptoms.

Neuropsychological testing is the most accurate method of pinpointing and documenting a person's cognitive problems and strengths.

Lab Tests

There is no lab test that confirms the diagnosis of NPH. Any lab tests that are done are probably being done to rule out conditions that might cause similar symptoms.

Imaging Tests

  • CT scan of the head: This scan is similar to an X-ray but gives a more detailed, 3-dimensional picture of the brain. It cannot confirm a diagnosis of NPH, but it can show ventricular enlargement or other changes that suggest NPH. Newer techniques can actually measure the flow of CSF in the brain. These findings alone may not be sufficient for diagnosis. This scan is safe and painless.
  • MRI of the head: This scan uses radio signals and a strong magnet to create a detailed picture of the brain. It is safe and painless, like a CT scan, but takes longer (about 30 minutes). It also cannot confirm a diagnosis of NPH.
  • Cisternography: This test is much more involved than CT scan or MRI and is not widely used. It highlights absorption of the CSF.



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