Normal pressure hydrocephalus awareness

Overview

Normal pressure hydrocephalus (NPH) is a condition where too much cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) builds up in the brain's cavities (ventricles). Despite the fluid buildup, the pressure in the brain usually stays normal. This extra fluid can stretch the brain and cause problems with walking, bladder control, and thinking.

Normal pressure hydrocephalus is not very common, but it is more common in older adults. It may be underdiagnosed because its symptoms can mimic normal aging or other conditions like Alzheimer's disease.

NPH mainly affects people over the age of 60. It can sometimes occur in younger adults or children, but that is rare.

Symptoms

Common symptoms

• Trouble walking – a person may feel like their feet are stuck to the floor, or they may have a slow, shuffling gait.
• Poor bladder control – needing to urinate urgently or leaking urine without warning.
• Problems with memory and thinking – such as forgetfulness, trouble concentrating, or slowed thinking.

Symptoms in children

• NPH in children is very rare, but similar symptoms can include gait problems, developmental delays, and changes in bladder control.

Symptoms in older adults

• Symptoms often start slowly and get worse over time. The walking problem is usually the first and most noticeable symptom.
• Older adults may also have increased falls, difficulty getting out of chairs, or a feeling of being off-balance.
• Changes in mental function, such as poor attention or loss of interest in activities, may also happen.

Causes

Main causes

• The exact cause is often unknown, but NPH happens when the fluid that surrounds the brain does not drain properly, leading to a buildup.
• Some cases may occur after a head injury, brain infection (like meningitis), brain surgery, or a bleed around the brain (subarachnoid hemorrhage).

Risk factors

• Being over 60 years of age
• Having had a head injury or brain surgery earlier in life
• A history of brain infections or bleeding in the brain

When to see a doctor

See a doctor urgently if:

• If you or a loved one has any of the emergency symptoms listed above, call your local emergency number immediately.
• If walking problems or bladder control changes happen very quickly (over a few days), seek urgent medical advice.

Book a routine appointment if:

• If you notice a slow, shuffling walk that seems to be getting worse, or if you are having more falls.
• If you or family members notice new memory problems, trouble thinking, or difficulty with daily tasks.
• If you are having trouble controlling your bladder that is not related to a simple infection.

Diagnosis

Doctors diagnose NPH by taking a medical history, doing a physical exam, and using brain imaging tests. They may also do a 'tap test' where a small amount of fluid is removed from the spine to see if symptoms improve.

Tests that may be done

• Brain imaging like a CT scan or MRI to look for enlarged ventricles (fluid-filled spaces).
• A lumbar puncture (spinal tap) to measure fluid pressure and sometimes remove fluid to see if walking improves.
• Sometimes a test called a 'tape test' where fluid is drained over a few days and symptoms are checked.

What to expect at your appointment

Diagnosis can take time. You may be referred to a neurologist (a doctor who specializes in the brain). The tests are generally safe. The lumbar puncture may cause a mild headache after, but this usually goes away with rest.

Treatment

Treatment for NPH focuses on removing the extra fluid to relieve pressure on the brain. The most common treatment is surgery to place a shunt (a thin tube) that drains fluid from the brain to another part of the body where it can be absorbed.

Self-care at home

• Stay active as much as possible – gentle walking or physical therapy can help with balance and strength.
• Make your home safer to prevent falls – remove rugs, add grab bars, and improve lighting.
• Keep a routine for bathroom breaks to manage bladder symptoms.

Medical treatments

There are no medications that treat NPH directly. Some medicines may be used for symptoms such as overactive bladder, but they do not treat the fluid buildup. Your doctor will talk to you about whether a shunt might help.

When is surgery considered?

Shunt surgery is the main treatment for NPH. It is often recommended if symptoms are getting worse and the person is otherwise healthy enough for surgery. The decision is made together with your neurosurgeon.

Living with this condition

Living with NPH means managing daily challenges. It can affect walking, bladder control, and thinking, but many people find ways to adapt. Using a cane or walker can help with balance. Bladder pads or scheduled bathroom breaks can bring peace of mind. Memory aids like notes or a calendar can help with thinking problems.

Lifestyle tips

• Stay socially active – talk with friends and family, join a support group if available.
• Plan your day to include rest breaks – fatigue is common.
• Consider occupational therapy to learn new ways to do everyday tasks.

Diet and exercise

A balanced diet with plenty of fruits, vegetables, and whole grains is good for overall health. Gentle exercise, like walking with a walker or chair exercises, can help maintain strength and balance. Always talk to your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Dealing with NPH can be frustrating and stressful. It is normal to feel sad, worried, or angry. Talking to a counselor or joining a support group can help. If you are feeling very low or hopeless, please reach out to a mental health professional or call a crisis hotline.

Prevention

There is no known way to prevent normal pressure hydrocephalus because most cases have no clear cause. However, protecting your head from injury (like wearing seatbelts and helmets) may lower the risk of secondary NPH.

Complications

If left untreated

• Worsening of walking problems, leading to more falls and possible injury.
• Progressive bladder and bowel control loss.
• Slow decline in thinking and memory that may become severe over time.

Long-term outlook

With early diagnosis and treatment – especially shunt surgery – many people see significant improvement in their walking and bladder control, and their thinking may stabilize or improve. NPH is considered one of the treatable causes of dementia, so there is hope. Even if surgery is not an option, supportive care can help maintain quality of life.

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