From the Research
Normal pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms: gait disturbance, urinary incontinence, and cognitive decline, with gait disturbance being the cardinal symptom, as noted in the study by 1. The gait disturbance typically appears first and is characterized by a slow, shuffling, wide-based "magnetic" gait, as if the feet are stuck to the floor. Urinary symptoms include urgency, frequency, and eventual incontinence. Cognitive impairment manifests as forgetfulness, slowed thinking, apathy, and difficulty with complex tasks, but is usually milder than in Alzheimer's disease. Some key points to consider in the diagnosis of NPH include:
- Brain imaging (CT or MRI) showing ventricular enlargement disproportionate to brain atrophy, with relatively preserved brain tissue
- Lumbar puncture with large-volume CSF removal (30-50 mL) as both diagnostic and predictive of treatment response; improvement in gait after CSF removal strongly suggests NPH, as seen in the study by 2
- Additional diagnostic tests, such as continuous lumbar drainage over 2-3 days, measurement of CSF opening pressure, and occasionally cisternography or intracranial pressure monitoring The diagnosis and management of NPH can be challenging, but early diagnosis is crucial as NPH is one of the few potentially reversible causes of dementia, with treatment involving surgical placement of a ventriculoperitoneal shunt to divert excess CSF, as discussed in the study by 3. It is essential to note that many patients do not present with classical clinical and radiological findings, making the diagnosis and management of NPH a challenge for the treating doctor, as highlighted in the study by 4. Overall, the classic symptoms of NPH and its diagnosis involve a combination of clinical signs and symptoms, radiographic findings, and diagnostic testing, with the goal of improving the patient's quality of life and reducing functional limitations and disability, as emphasized in the study by 5.