From the Research
Normal pressure hydrocephalus (NPH) should be treated with surgical placement of a ventriculoperitoneal (VP) shunt as soon as possible after diagnosis, as this can significantly improve symptoms and quality of life, with studies showing improvement in 70% to 90% of treated patients 1.
Diagnosis and Treatment
NPH is a neurological condition characterized by the triad of gait disturbance, urinary incontinence, and cognitive decline, caused by excess cerebrospinal fluid accumulation in the brain ventricles despite normal pressure readings. The primary treatment for NPH is surgical placement of a VP shunt to drain excess fluid from the brain to the abdominal cavity. Diagnosis typically involves:
- Clinical evaluation
- Brain imaging (MRI or CT)
- A lumbar tap test or extended lumbar drainage to assess symptom improvement with fluid removal Early diagnosis and treatment are crucial, as NPH symptoms can be partially or significantly reversed with proper intervention, especially gait problems which tend to respond best.
Importance of Early Treatment
The condition primarily affects adults over 60 and may be idiopathic or secondary to conditions like head trauma, subarachnoid hemorrhage, or meningitis. Without treatment, NPH progressively worsens, potentially leading to severe disability. Medical management alone is generally ineffective, making surgical intervention the standard of care for those who are suitable candidates and show positive response to diagnostic fluid removal tests 2. Recent advances in non-invasive MRI methods for quantifying cerebral blood flow, such as arterial spin-labeling (ASL), offer new avenues to understand and treat NPH 2.
Key Considerations
- NPH is an important cause of potentially reversible dementia, frequent falls, and recurrent urinary infections in the elderly 2.
- The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments 2.
- Shunt failures are related to the placement method, with laparoscopic surgery carrying distinct advantages such as shorter operating room times and hospital stays, which should translate into less use of pain medications, earlier mobilization, and a lower incidence of ileus 3.