Normal Pressure Hydrocephalus

Hydrocephalus is a buildup of fluid in the brain. The fluid is called cerebrospinal fluid (CSF).
Cerebrospinal fluid:

• Is made in the brain.

• Protects the brain and spinal cord.

• Helps balance nutrients in the nervous system.

• Is absorbed into the bloodstream.

The most common type of fluid buildup in adults 60 and older is normal pressure hydrocephalus (NPH). The fluid slowly builds up. We do not fully understand why this happens. The more fluid builds ups the more it puts pressure on your brain.
A small amount of fluid does not cause problems. If you have a large amount of fluid in your brain, it can cause problems with walking or your memory.

What may cause NPH?

Your brain may make too much cerebrospinal fluid. Your body may not absorb the fluid the way it should. The pathway for the fluid may be blocked. We do not always know why this happens.
The cause of NPH could be:

• A brain injury

• A brain surgery

• Tumors

• An infection

• Bleeding in the brain

• Swollen blood vessels in the brain

What are the symptoms?

NPH may not cause any clear symptoms at first. It can cause many different symptoms. The three most common symptoms are:
1. Trouble walking

• Feeling mildly off balance

• Not being able to stand or walk

• Walking with a short, slow and shuffling stride

• Walking with your feet spread wide apart

• Having trouble picking up your feet, as they feel stuck to the floor

• Hard time going up and down stairs and curbs

• Falling

2. Memory problems

• Losing interest in your activities

• Forgetting

• Having trouble doing daily tasks

• Short-term memory loss

3. Loss of bladder control

• Feeling the need to urinate more often than usual

• Having strong, urgent needs to urinate every 1 to 2 hours

• Urine leaking

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history. The exam will focus on your nervous system.
There are no simple tests for NPH. If you have 2 or 3 of the most common symptoms, you may have a CT scan or an MRI scan of your brain.
A CT scan will take pictures of your brain using an x-ray and a computer. An MRI will take pictures of your brain using a strong magnetic field and radio waves.
The CT or MRI scan will show if you have: 

• Enlarged spaces in your brain where CSF is made

• Blockage

• Pressure on part of your brain

You may also have a neuropsychological test. The doctor will ask you a series of questions. The test will check for a loss of brain function. It will help rule out dementia from NPH memory problems.

How do we treat NPH?

NPH is an ongoing, long-term condition. Most people with NPH can lead a normal life with treatment.
The treatment in most cases is surgery to put in a shunt. The shunt is made up of a tube and a valve.
A one-way valve in the shunt opens when fluid builds up in your brain. The shunt allows extra fluid to drain into your abdominal cavity, in most cases. Your abdomen will then absorb the fluid.
The most common shunt is called a ventriculoperitoneal shunt or VP shunt. The tube of the shunt runs down from your skull under the skin of your neck and chest. It ends in the space between your bowels and the wall of your abdomen. The pressure from the fluid on your brain will stop and you will get better when the shunt does its job.
Shunt placement is not a good option for some people. If there are memory concerns, shunt placement may not be a good option for you. A careful screening process is done to go over the risks and benefits.
There are also other types of surgery to treat NPH without using a shunt.

How do I take care of myself?

How you take care of yourself will depend on what type of problems NPH causes for you. You may need to stay where family or caregivers can help you if you have trouble walking or memory problems.
Ask your provider:

• How and when you will hear your test results

• How long it will take to recover

• What activities to stay away from

• When you can return to your normal activities

• How to take care of yourself at home

• What symptoms or problems you should watch for and what to do if you have them

• When you should come back for a checkup

Make sure to follow your healthcare provider's instructions.