Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jun 2 2019

Normal Pressure Hydrocephalus

  • Snapshot
    • A 71-year-old man presents to his neurologist for gait difficulties. He is accompanied by his wife who said that he takes short steps and has had episodes of urinary incontinence. He denies any head trauma or recent infectious symptoms. Physical examination is notable for magnetic gait; however, the rest of the neurological assessment is unremarkable. An MRI brain is performed, which demonstates ventricular enlargement without ischemic changes. He undergoes a large volume lumbar puncture, and 45 minutes after the tap his gait significantly improves. He is referred to neurosurgery for ventricular shunting.
  • Introduction
    • Definition
      • a form of communicating hydrocephalus leading to pathologically enlarged ventricles with normal opening pressure on lumbar puncture
    • Associated conditions
      • Alzheimer disease
      • vascular dementia
  • Epidemiology
    • Incidence
      • idiopathic normal pressure hydrocephalus (NPH) is more common in elderly patients
  • Etiology
    • Idiopathic
    • Secondary causes include
      • subarachnoid hemorrhage
      • meningitis
      • traumatic brain injury
      • neurosurgery
      • brain radiation
  • Pathogenesis
    • Unknown in idiopathic cases
    • In secondary NPH cases
      • reduced cerebrospinal fluid reabsorption secondary to inflammation and subsequent fibrosis of the arachnoid granulations and/or base of the brain
  • Presentation
    • Symptoms 
      • cognitive disturbances (occurs months to years after gait dysfunction)
        • impaired executive function (found early)
        • poor attention and concentration
        • psychomotor slowiing
        • apathy
    • Physical exam
      • gait dysfunction
        • wide-based magnetic gait ("glue-footed")
      • urinary incontinence
        • typically urinary urgency first
  • Imaging
    • MRI brain
      • indication
        • superior to CT scan in the evaluation of NPH
      • findings
        • ventriculomegaly (hallmark finding)
        • periventricular white matter changes
  • Studies
    • High-volume lumbar puncture
      • assess gait before the lumbar puncture (LP) and 30-60 minutes after the LP
  • Differential
    • Parkinson disease
      • differentiating factors
        • patients have a resting tremor, bradykinesia, and rigidity
    • Vascular dementia
      • differentiating factors
        • patients have ischemic changes on MRI brain
  • Treatment
    • Operative
      • ventricular shunting
        • indication
          • treatment of choice in patients with clinical and imaging findings of NPH
  • Complications
    • Falls
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options