From the Research
Normal pressure hydrocephalus (NPH) is a neurological condition characterized by the triad of gait disturbance, urinary incontinence, and cognitive decline, as reported in a recent study 1. The symptoms of NPH can be summarized as follows:
- Gait disturbance: characterized by a magnetic gait, which is a slow and unsteady gait, often with a wide base and difficulty initiating steps
- Urinary incontinence: often presenting as urge incontinence, with a sudden and intense need to urinate
- Cognitive decline: which can range from mild cognitive impairment to dementia, with symptoms such as memory loss, difficulty with concentration and attention, and decreased processing speed
These symptoms can have a significant impact on a patient's quality of life, and it is essential to diagnose and treat NPH promptly to prevent further decline. The diagnosis of NPH is typically made based on a combination of clinical evaluation, brain imaging (such as MRI or CT), and lumbar puncture with high-volume CSF removal (30-50 mL) as a diagnostic trial, as described in a study published in 2024 2. The most recent and highest quality study on NPH, published in 2024, found that the symptoms of NPH can be improved with ventriculoperitoneal shunt placement, with significant improvements in mobility, cognition, and social roles and activity participation 1. It is essential to note that the success rate for shunting in properly selected patients is approximately 60-80%, with better outcomes typically seen in those with predominant gait disturbance and shorter symptom duration, as reported in a study published in 2019 3. In terms of treatment, surgical placement of a ventriculoperitoneal (VP) shunt is the primary treatment option for NPH, as it can help to drain excess cerebrospinal fluid from the brain ventricles and improve symptoms, as described in a study published in 2015 4. Overall, the symptoms of NPH can have a significant impact on a patient's quality of life, and prompt diagnosis and treatment are essential to prevent further decline. Some key points to consider when diagnosing and treating NPH include:
- The importance of early diagnosis and treatment to prevent further decline
- The use of brain imaging and lumbar puncture with high-volume CSF removal as diagnostic tools
- The role of ventriculoperitoneal shunt placement in improving symptoms
- The need for regular follow-up to monitor for complications such as infection, over-drainage, or shunt malfunction, as reported in a study published in 2019 5.