normal pressure hydrocephalus

Summary

Summary: A form of compensated hydrocephalus characterized clinically by a slowly progressive gait disorder (see GAIT DISORDERS, NEUROLOGIC), progressive intellectual decline, and URINARY INCONTINENCE. Spinal fluid pressure tends to be in the high normal range. This condition may result from processes which interfere with the absorption of CSF including SUBARACHNOID HEMORRHAGE, chronic MENINGITIS, and other conditions. (From Adams et al., Principles of Neurology, 6th ed, pp631-3)

Top Publications

  1. Meier U, König A, Miethke C. Predictors of outcome in patients with normal-pressure hydrocephalus. Eur Neurol. 2004;51:59-67 pubmed
    ..min/ml, the CSF tap test was positive and a Miethke Dual-Switch valve was implanted. ..
  2. Agren Wilsson A, Lekman A, Sjoberg W, Rosengren L, Blennow K, Bergenheim A, et al. CSF biomarkers in the evaluation of idiopathic normal pressure hydrocephalus. Acta Neurol Scand. 2007;116:333-9 pubmed
    ..evaluate cerebrospinal fluid (CSF) markers for neuronal degeneration and demyelination in idiopathic normal pressure hydrocephalus (INPH), subcortical arteriosclerotic encephalopathy (SAE), and neurologically healthy subjects...
  3. Luetmer P, Huston J, Friedman J, Dixon G, Petersen R, Jack C, et al. Measurement of cerebrospinal fluid flow at the cerebral aqueduct by use of phase-contrast magnetic resonance imaging: technique validation and utility in diagnosing idiopathic normal pressure hydrocephalus. Neurosurgery. 2002;50:534-43; discussion 543-4 pubmed
    ..elderly patients, patients with Alzheimer's and other forms of dementia, and patients with idiopathic normal pressure hydrocephalus (NPH). A constant flow phantom was used to establish the accuracy of the CSF flow measurement...
  4. Li X, Miyajima M, Mineki R, Taka H, Murayama K, Arai H. Analysis of potential diagnostic biomarkers in cerebrospinal fluid of idiopathic normal pressure hydrocephalus by proteomics. Acta Neurochir (Wien). 2006;148:859-64; discussion 864 pubmed
    The pathogenesis of idiopathic normal pressure hydrocephalus (INPH) is unknown, and the syndrome of INPH remains a diagnostic and therapeutic challenge...
  5. Ng S, Low A, Tang K, Chan Y, Kwok R. Value of quantitative MRI biomarkers (Evans' index, aqueductal flow rate, and apparent diffusion coefficient) in idiopathic normal pressure hydrocephalus. J Magn Reson Imaging. 2009;30:708-15 pubmed publisher
    ..index (EI), aqueductal flow rate (FR), and apparent diffusion coefficient (ADC) in the diagnosis of normal pressure hydrocephalus (NPH) and to assess the ability of these markers preoperatively to predict shunt response...
  6. Aboul Enein F, Kristoferitsch W. Normal pressure hydrocephalus or neuroborreliosis?. Wien Med Wochenschr. 2009;159:58-61 pubmed publisher
    ..Clinical improvement after CSF spinal tap test suggested a normal pressure hydrocephalus syndrome...
  7. Sakakibara R, Uchiyama T, Kanda T, Uchida Y, Kishi M, Hattori T. [Urinary dysfunction in idiopathic normal pressure hydrocephalus]. Brain Nerve. 2008;60:233-9 pubmed
    ..UI is well known as a clinical triad for the diagnosis of normal pressure hydrocephalus (NPH)...
  8. Kahlon B, Sundbärg G, Rehncrona S. Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 2002;73:721-6 pubmed
    ..fluid (CSF) tap test for predicting the outcome of shunt surgery in patients with suspected normal pressure hydrocephalus. 68 patients with suspected normal pressure hydrocephalus were studied...
  9. Barada W, Najjar M, Beydoun A. Early onset tension pneumocephalus following ventriculoperitoneal shunt insertion for normal pressure hydrocephalus: a case report. Clin Neurol Neurosurg. 2009;111:300-2 pubmed publisher
    ..We report a patient who developed an acute subdural tension pneumocephalus within 1 day following placement of a v.p. shunt for normal pressure hydrocephalus as a complication from shunt surgery.

More Information

Publications62

  1. Komotar R, Zacharia B, Mocco J, Kaiser M, Frucht S, McKhann G. Cervical spine disease may result in a negative lumbar spinal drainage trial in normal pressure hydrocephalus: case report. Neurosurgery. 2008;63:315; discussion 315 pubmed publisher
    In this case report, we present a patient with normal pressure hydrocephalus in whom a lumbar drainage trial yielded a false-negative result secondary to cervical spondylosis...
  2. Conn H. Normal pressure hydrocephalus: a case report by a physician who is the patient. Clin Med (Lond). 2007;7:296-9 pubmed
    ..After ten years of progressive illness the correct diagnosis of normal pressure hydrocephalus (NPH) was finally made, revealing itself, by accident, through incontinence and mild dementia...
  3. Tarkowski E, Tullberg M, Fredman P, Wikkelso C. Normal pressure hydrocephalus triggers intrathecal production of TNF-alpha. Neurobiol Aging. 2003;24:707-14 pubmed
    b>Normal pressure hydrocephalus (NPH) is associated with periventricular white matter lesions and demyelination...
  4. Kazui H. [Cognitive impairment in patients with idiopathic normal pressure hydrocephalus]. Brain Nerve. 2008;60:225-31 pubmed
    The major cognitive impairment in patients with idiopathic normal pressure hydrocephalus (iNPH) is frontal lobe symptoms, such as psychomotor slowing and impairment of attention, working memory, verbal fluency and executive function...
  5. Li X, Miyajima M, Jiang C, Arai H. Expression of TGF-betas and TGF-beta type II receptor in cerebrospinal fluid of patients with idiopathic normal pressure hydrocephalus. Neurosci Lett. 2007;413:141-4 pubmed
    We investigated cerebrospinal fluid (CSF) samples from 21 patients with idiopathic normal pressure hydrocephalus (INPH) and 14 controls without neurological disease...
  6. Algin O, Hakyemez B, Parlak M. The efficiency of PC-MRI in diagnosis of normal pressure hydrocephalus and prediction of shunt response. Acad Radiol. 2010;17:181-7 pubmed publisher
    ..the efficiency of phase-contrast magnetic resonance imaging (PC-MRI) in the diagnosis of idiopathic normal pressure hydrocephalus (INPH) and prediction of shunt response...
  7. Hellström P, Edsbagge M, Blomsterwall E, Archer T, Tisell M, Tullberg M, et al. Neuropsychological effects of shunt treatment in idiopathic normal pressure hydrocephalus. Neurosurgery. 2008;63:527-35; discussion 535-6 pubmed publisher
    ..evaluate the effects of shunting on the neuropsychological performance of patients with idiopathic normal pressure hydrocephalus (INPH), to compare their performance with that of healthy individuals, and to estimate the predictive ..
  8. Blomsterwall E, Svantesson U, Carlsson U, Tullberg M, Wikkelso C. Postural disturbance in patients with normal pressure hydrocephalus. Acta Neurol Scand. 2000;102:284-91 pubmed
    The postural function in 52 patients with normal pressure hydrocephalus (NPH) and in 19 patients with subcortical arteriosclerotic encephalopathy (SAE) was analysed bedside and in 17 of the NPH, 10 of the SAE and 23 healthy individuals (..
  9. Ishikawa M, Oowaki H, Matsumoto A, Suzuki T, Furuse M, Nishida N. Clinical significance of cerebrospinal fluid tap test and magnetic resonance imaging/computed tomography findings of tight high convexity in patients with possible idiopathic normal pressure hydrocephalus. Neurol Med Chir (Tokyo). 2010;50:119-23; disucussion 123 pubmed
    Idiopathic normal pressure hydrocephalus (iNPH) is a treatable syndrome with a classical triad of symptoms...
  10. Lee P, Yong S, Ahn Y, Huh K. Correlation of midbrain diameter and gait disturbance in patients with idiopathic normal pressure hydrocephalus. J Neurol. 2005;252:958-63 pubmed
    Although gait disturbance is an important feature of idiopathic normal pressure hydrocephalus (NPH), only tentative theories have been offered to explain its pathophysiology...
  11. Mesure S, Donnet A, Azulay J, Pouget J, Grisoli F. [Postural and locomotor evaluation of normal pressure hydrocephalus: a case report]. Rev Neurol (Paris). 2001;157:1416-9 pubmed
    Generally, the diagnosis of idiopathic normal pressure hydrocephalus (NPH) is raised in elderly patients with an association of gait disturbances, cognitive impairment, urinary incontinence and widening of the ventricles...
  12. Ishii K, Kawaguchi T, Shimada K, Ohkawa S, Miyamoto N, Kanda T, et al. Voxel-based analysis of gray matter and CSF space in idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord. 2008;25:329-35 pubmed publisher
    To investigate regional morphologic changes in idiopathic normal pressure hydrocephalus (INPH) based on diagnosis with INPH Guidelines using voxel-based morphometry...
  13. Fraser J, Fraser C. Gait disorder is the cardinal sign of normal pressure hydrocephalus: a case study. J Neurosci Nurs. 2007;39:132-4, 192 pubmed
    b>Normal pressure hydrocephalus (NPH) is one of the few reversible causes of dementia in older adults and accounts for approximately 6% of all dementias...
  14. Eide P, Sorteberg W. Diagnostic intracranial pressure monitoring and surgical management in idiopathic normal pressure hydrocephalus: a 6-year review of 214 patients. Neurosurgery. 2010;66:80-91 pubmed publisher
    To review our experience of managing idiopathic normal pressure hydrocephalus (iNPH) during the 6-year period from 2002 to 2007, when intracranial pressure (ICP) monitoring was part of the diagnostic workup...
  15. Hoglund M, Tisell M, Wikkelsø C. [Incidence of surgery for hydrocephalus in adults surveyed: same number afflicted by hydrocephalus as by multiple sclerosis]. Lakartidningen. 2001;98:1681-5 pubmed
    ..3 to 6.3. The mean age was 60 years (range 18-92), with no sex difference. Normal pressure hydrocephalus (47%) was most common, followed by communicating high pressure hydrocephalus (27%) and aqueductal ..
  16. Krefft T, Graff Radford N, Lucas J, Mortimer J. Normal pressure hydrocephalus and large head size. Alzheimer Dis Assoc Disord. 2004;18:35-7 pubmed
    To determine if patients with normal pressure hydrocephalus (NPH) have larger head size than normal controls. In 1989, Graff-Radford and Godersky noted that 3 of 30 patients diagnosed with NPH had large heads...
  17. Ouchi Y, Nakayama T, Kanno T, Yoshikawa E, Shinke T, Torizuka T. In vivo presynaptic and postsynaptic striatal dopamine functions in idiopathic normal pressure hydrocephalus. J Cereb Blood Flow Metab. 2007;27:803-10 pubmed
    Differentiation of impaired gait seen in idiopathic normal pressure hydrocephalus (iNPH) from parkinsonian gait is sometimes a great challenge and important for future medication in the clinical setting...
  18. Brean A, Fredø H, Sollid S, Muller T, Sundstrøm T, Eide P. Five-year incidence of surgery for idiopathic normal pressure hydrocephalus in Norway. Acta Neurol Scand. 2009;120:314-6 pubmed publisher
    We have previously determined the incidence and prevalence of idiopathic normal pressure hydrocephalus (iNPH) in the county of Vestfold in Norway. This study aimed at determining the incidence of surgeries for iNPH...
  19. Hellström P, Edsbagge M, Archer T, Tisell M, Tullberg M, Wikkelsø C. The neuropsychology of patients with clinically diagnosed idiopathic normal pressure hydrocephalus. Neurosurgery. 2007;61:1219-26; discussion 1227-8 pubmed
    To compare the neuropsychological performance of patients with idiopathic normal pressure hydrocephalus (INPH) with that of healthy individuals and to examine its relation to neurological signs, vascular comorbidity, and background ..
  20. Sasani M, Ozer F, Oktenoglu T, Tokatli I, Sarioglu A. Delayed and isolated intraventricular tension pneumocephalus after shunting for normal pressure hydrocephalus. Neurol India. 2007;55:81-2 pubmed
  21. Sasaki H, Ishii K, Kono A, Miyamoto N, Fukuda T, Shimada K, et al. Cerebral perfusion pattern of idiopathic normal pressure hydrocephalus studied by SPECT and statistical brain mapping. Ann Nucl Med. 2007;21:39-45 pubmed
    To investigate the specific pattern of cerebral blood flow (CBF) in subjects with idiopathic normal pressure hydrocephalus (iNPH) using voxel-based analysis...
  22. Brettschneider J, Riepe M, Petereit H, Ludolph A, Tumani H. Meningeal derived cerebrospinal fluid proteins in different forms of dementia: is a meningopathy involved in normal pressure hydrocephalus?. J Neurol Neurosurg Psychiatry. 2004;75:1614-6 pubmed
    ..Patients with idiopathic normal pressure hydrocephalus (NPH) (17.5 (SD 4...
  23. Bret P, Guyotat J, Chazal J. Is normal pressure hydrocephalus a valid concept in 2002? A reappraisal in five questions and proposal for a new designation of the syndrome as "chronic hydrocephalus". J Neurol Neurosurg Psychiatry. 2002;73:9-12 pubmed
    The authors question the current validity of the traditional concept of normal pressure hydrocephalus (NPH) as it was described by Adams and Hakim in 1965. The classic features of the disease are addressed...
  24. Governale L, Fein N, Logsdon J, Black P. Techniques and complications of external lumbar drainage for normal pressure hydrocephalus. Neurosurgery. 2008;63:379-84; discussion 384 pubmed publisher
    To describe our system of external lumbar drainage for normal pressure hydrocephalus, detail its complications, and discuss changes made to that system with time...
  25. Factora R, Luciano M. Normal pressure hydrocephalus: diagnosis and new approaches to treatment. Clin Geriatr Med. 2006;22:645-57 pubmed
    ..When they appear over time in the same patient, however, these symptoms raise the possibility of normal pressure hydrocephalus.
  26. Iddon J, Pickard J, Cross J, Griffiths P, Czosnyka M, Sahakian B. Specific patterns of cognitive impairment in patients with idiopathic normal pressure hydrocephalus and Alzheimer's disease: a pilot study. J Neurol Neurosurg Psychiatry. 1999;67:723-32 pubmed
    Eleven patients with idiopathic normal pressure hydrocephalus (NPH) were selected from an initial cohort of 43 patients...
  27. Tullberg M, Persson J, Petersen J, Hellström P, Wikkelsø C, Lundgren Nilsson Ã. Shunt surgery in idiopathic normal pressure hydrocephalus is cost-effective-a cost utility analysis. Acta Neurochir (Wien). 2018;160:509-518 pubmed publisher
    The objective was to evaluate the cost-effectiveness of shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH)...
  28. Mullaguri N, Battineni A, Newey C, Nattanmai P. White Matter Changes in Corpus Callosum in a Patient with Idiopathic Normal Pressure Hydrocephalus. J Neurosci Rural Pract. 2017;8:657-659 pubmed publisher
    Idiopathic normal pressure hydrocephalus (INPH) is characterized by the clinical triad of gait and cognitive dysfunction and urinary incontinence. Ventriculoperitoneal (VP) shunting is often required for treatment...
  29. Levin O, Chimagomedova A, Skripkina N, Lyashenko E, Babkina O. Nonmotor Symptoms in Vascular and Other Secondary Parkinsonism. Int Rev Neurobiol. 2017;134:1303-1334 pubmed publisher
    ..Clinical value of nonmotor symptoms in normal pressure hydrocephalus, toxic, and drug-induced parkinsonism is also discussed.
  30. Nocuń A, Mosiewicz A, Kaczmarczyk R, Kazalska T, Czekajska Chehab E, Chrapko B, et al. Early brain perfusion improvement after ventriculoperitoneal shunt surgery in patients with idiopathic normal pressure hydrocephalus evaluated by 99mTc-HMPAO SPECT - preliminary report. Nucl Med Rev Cent East Eur. 2015;18:84-8 pubmed publisher
    Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome that consists of the triad: gait disturbance, mental deterioration and urinary incontinence associated with normal cerebrospinal fluid pressure (CSF), without pre-..
  31. Friedman J. Normal pressure hydrocephalus. Med Health R I. 2004;87:358 pubmed
  32. Liouta E, Gatzonis S, Kalamatianos T, Kalyvas A, Koutsarnakis C, Liakos F, et al. Finger tapping and verbal fluency post-tap test improvement in INPH: its value in differential diagnosis and shunt-treatment outcomes prognosis. Acta Neurochir (Wien). 2017;159:2301-2307 pubmed publisher
    Idiopathic normal pressure hydrocephalus (INPH) diagnosis is challenging as it can be mimicked by other neurological conditions, such as neurodegenerative dementia and motor syndromes...
  33. Ganslandt O, Fahrig A, Strauss C. Hemorrhage into cystic vestibular schwannoma following stereotactic radiation therapy. Zentralbl Neurochir. 2008;69:204-6 pubmed publisher
    ..Since hemorrhage seems to be a relevant risk in large cystic vestibular schwannomas, a surgical treatment should be preferred whenever possible. ..
  34. Wolfsegger T, Topakian R. Cognitive impairment predicts worse short-term response to spinal tap test in normal pressure hydrocephalus. J Neurol Sci. 2017;379:222-225 pubmed publisher
    In patients with idiopathic normal pressure hydrocephalus (iNPH), the spinal tap test (STT) is commonly used to predict ventriculoperitoneal shunt responsiveness...
  35. Bradley W. Cerebrospinal fluid dynamics and shunt responsiveness in patients with normal-pressure hydrocephalus. Mayo Clin Proc. 2002;77:507-8 pubmed
  36. Wilson R, Williams M. Normal pressure hydrocephalus. Clin Geriatr Med. 2006;22:935-51, viii pubmed
    b>Normal pressure hydrocephalus (NPH) is a reversible disorder characterized by gait impairment, subcortical dementia, and urinary urgency and incontinence associated with impaired cerebrospinal fluid circulation and ventriculomegaly...
  37. Kiefer M, Eymann R, Steudel W. Outcome predictors for normal-pressure hydrocephalus. Acta Neurochir Suppl. 2006;96:364-7 pubmed
  38. Nagata Y, Bundo M, Sugiura S, Kamita M, Ono M, Hattori K, et al. PTPRQ as a potential biomarker for idiopathic normal pressure hydrocephalus. Mol Med Rep. 2017;16:3034-3040 pubmed publisher
    Idiopathic normal pressure hydrocephalus (iNPH) is caused by the accumulation of cerebrospinal fluid (CSF) and is characterized by gait disturbance, urinary incontinence, and dementia...
  39. Sasaki M, Honda S, Yuasa T, Iwamura A, Shibata E, Ohba H. Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI. Neuroradiology. 2008;50:117-22 pubmed
    ..and high midline areas, which is speculated to be one of the clinical characteristics of idiopathic normal pressure hydrocephalus (iNPH)...
  40. Wilson R, Williams M. What we gain by measuring head circumference. Pediatrics. 2008;122:219-20; author reply 220-1 pubmed publisher
  41. Bradley W, Safar F, Furtado C, Hurtado C, Ord J, Alksne J. Increased intracranial volume: a clue to the etiology of idiopathic normal-pressure hydrocephalus?. AJNR Am J Neuroradiol. 2004;25:1479-84 pubmed
    ..The patients somehow remain asymptomatic until their later years, when a second insult must occur, leading to symptomatic NPH. ..
  42. Chong C, van Gelder J, Sheridan M. Clinical experience with the low pressure Novus valve in the treatment of adult hydrocephalus. J Clin Neurosci. 2002;9:539-43 pubmed
    ..The major causes of hydrocephalus were intracranial haemorrhage (18), tumour (10), normal pressure hydrocephalus (10) and trauma (9). Forty one procedures were first shunts and eleven were revisions...
  43. Bachmeyer C, Khalil A, Bouvard E, Langman B, Le Guerinel C. [An overdrainage]. Rev Med Interne. 2007;28:782-3 pubmed
  44. Meier U, Mutze S. Correlation between decreased ventricular size and positive clinical outcome following shunt placement in patients with normal-pressure hydrocephalus. J Neurosurg. 2004;100:1036-40 pubmed
    ..A postoperative change in ventricular volume should be assessed differently in patients with NPH compared with those suffering from hypertensive hydrocephalus. ..
  45. Eide P, Fremming A, Sorteberg A. Lack of relationship between resistance to cerebrospinal fluid outflow and intracranial pressure in normal pressure hydrocephalus. Acta Neurol Scand. 2003;108:381-8 pubmed
    ..constant rate infusion test in a reliable way predicts the intracranial pressure (ICP) profile in normal pressure hydrocephalus (NPH)...
  46. Pyykkö O, Nerg O, Niskasaari H, Niskasaari T, Koivisto A, Hiltunen M, et al. Incidence, Comorbidities, and Mortality in Idiopathic Normal Pressure Hydrocephalus. World Neurosurg. 2018;112:e624-e631 pubmed publisher
    To investigate the incidence, comorbidities, mortality, and causes of death in idiopathic normal pressure hydrocephalus (iNPH). A cohort of 536 patients with possible NPH from a defined population with a median follow-up time of 5...
  47. Dennhardt J, LeDoux M. Huntington disease in a nonagenarian mistakenly diagnosed as normal pressure hydrocephalus. J Clin Neurosci. 2010;17:1066-7 pubmed publisher
    ..with HD who did not manifest overt chorea until 91 years of age and was mistakenly diagnosed with normal pressure hydrocephalus at 89 years of age...
  48. Jaraj D, Agerskov S, Rabiei K, Marlow T, Jensen C, Guo X, et al. Vascular factors in suspected normal pressure hydrocephalus: A population-based study. Neurology. 2016;86:592-9 pubmed publisher
    We examined clinical and imaging findings of suspected idiopathic normal pressure hydrocephalus (iNPH) in relation to vascular risk factors and white matter lesions (WMLs), using a nested case-control design in a representative, ..
  49. Johansson E, Ambarki K, Birgander R, Bahrami N, Eklund A, Malm J. Cerebral microbleeds in idiopathic normal pressure hydrocephalus. Fluids Barriers CNS. 2016;13:4 pubmed publisher
    A vascular disease could be involved in pathophysiology of normal pressure hydrocephalus (INPH). If so, there should be an association between INPH and cerebral microbleeds (CMB)...
  50. Kim M, Eide P, O Rourke M, Adji A, Avolio A. Intracranial Pressure Waveforms are More Closely Related to Central Aortic than Radial Pressure Waveforms: Implications for Pathophysiology and Therapy. Acta Neurochir Suppl. 2016;122:61-4 pubmed publisher
    ..Hence, monitoring central aortic pressure through derivation from the radial pressure wave is superior to measurement of radial pressure alone. ..
  51. Tsakanikas D, Relkin N. Normal pressure hydrocephalus. Semin Neurol. 2007;27:58-65 pubmed
    Idiopathic normal pressure hydrocephalus (INPH) is a treatable neurological disorder in older adults involving disturbances of gait/balance, control of micturition, and/or cognition in combination with enlargement of the cerebral ..
  52. De Bonis P, Novegno F, Tamburrini G, Anile C, Pompucci A, Mangiola A. Teaching NeuroImage: Prepontine-suprasellar arachnoid cyst presenting with signs of normal pressure hydrocephalus. Neurology. 2008;70:e26 pubmed publisher
  53. Grigorean V, Sandu A, Popescu M, Florian I, Lupascu C, Ursulescu C. Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers. Neurol Neurochir Pol. 2017;51:290-298 pubmed publisher
    ..VEp shunt in 15 patients: 5 with congenital hydrocephalus, 8 with secondary hydrocephalus and 2 with normal pressure hydrocephalus. There were 7 men and 8 women...