From the Research
For a patient with Normal Pressure Hydrocephalus (NPH), I recommend drawing basic labs including complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid stimulating hormone (TSH), vitamin B12 level, and folate level. These tests help rule out other conditions that can mimic NPH symptoms, such as infections, blood disorders, kidney and liver dysfunction, electrolyte imbalances, and glucose abnormalities 1. The CBC can identify infections or blood disorders, while the CMP assesses kidney and liver function, electrolyte balance, and glucose levels. Thyroid dysfunction can present with cognitive impairment similar to NPH, making TSH essential 2. Vitamin B12 and folate deficiencies can cause gait disturbances and cognitive decline that might be confused with NPH.
Some key points to consider when ordering labs for NPH patients include:
- Ruling out other conditions that can cause similar symptoms, such as syphilis or HIV, especially in patients with risk factors 3
- Assessing kidney and liver function, as well as electrolyte balance and glucose levels, to identify potential underlying causes of symptoms 1
- Considering the potential impact of axonal degeneration and tau pathology on NPH symptoms, as suggested by recent studies 4
- Keeping in mind that lab tests alone cannot diagnose NPH, but are crucial for excluding alternative diagnoses that may require different treatment approaches 2
In terms of specific lab tests, the following may be considered:
- Complete blood count (CBC) to identify infections or blood disorders
- Comprehensive metabolic panel (CMP) to assess kidney and liver function, electrolyte balance, and glucose levels
- Thyroid stimulating hormone (TSH) to evaluate thyroid function
- Vitamin B12 and folate levels to assess for deficiencies that may cause similar symptoms
- Syphilis serology (RPR or VDRL) and HIV testing in patients with risk factors, as these infections can cause neurological symptoms resembling NPH 3