Normal Pressure Hydrocephalus (NPH)

Peter O'Donnell Jr. Brain Institute

Appointment New Patient Appointment or 214-645-8300

UT Southwestern Medical Center provides expert care for normal pressure hydrocephalus (NPH), a condition in which excess fluid collects in the brain.

With diagnosis and care from our multidisciplinary team, patients with NPH can stabilize their condition and even reverse the symptoms to some degree. Few health care centers have the NPH expertise that UT Southwestern does.

Leading-Edge, Patient-Centered Care for Normal Pressure Hydrocephalus

Cerebrospinal fluid (CSF) is a clear substance that is continuously produced by blood vessels in the brain and then recycled into circulation. This cycle is important for cleansing brain tissue.

NPH occurs when the path to recycle CSF becomes partially blocked or plugged. Excess CSF accumulates, leaving less space for the brain, and the cleansing cycle becomes less effective.

This results in gradual impairment of brain function. We don’t know how much of the impairment is due to compression from excess CSF or ineffective cleansing.

Symptoms of NPH often mimic those of neurodegenerative diseases such as Alzheimer’s or Parkinson’s, and up to 80% of patients with NPH go untreated or are misdiagnosed. NPH is relatively treatable compared with those neurodegenerative diseases.

With a robust patient database tracking treatment outcomes and a multidisciplinary approach – involving experts from neurology, neurosurgery, psychiatry, and physical medicine and rehabilitation – UT Southwestern is home to one of the top centers in the country for diagnosing and treating NPH.

Normal Pressure Hydrocephalus Causes

Most common in people of advanced age (over 70), NPH may be caused by a blockage in the normal flow of cerebrospinal fluid through the meninges, which form the lining on the surface of the brain.

The cause of this blockage is often unknown. In some cases, it is a secondary result of one of the following medical conditions:

  • Head injury
  • Surgery complications
  • Subarachnoid hemorrhage (bleeding in the area around the brain)
  • Brain tumors
  • Brain infections (such as meningitis)
  • Brain inflammation

Symptoms of Normal Pressure Hydrocephalus

NPH is often misdiagnosed as a neurodegenerative disease, such as Alzheimer’s or Parkinson’s, because its symptoms are similar. NPH may also occur simultaneously with a neurodegenerative disease.

The most common symptoms, known as Hakim’s triad, are:

  • Difficulty walking (such as trouble lifting the feet or walking steadily)
  • Poor bladder control
  • Cognitive impairment (for example, confusion or forgetfulness)

At least half of people with NPH demonstrate all these symptoms at once.

Additional symptoms may include:

  • Balance problems
  • Slowed movement
  • Depression or other mood changes
  • Dizziness

Diagnosing Normal Pressure Hydrocephalus

Diagnosis of NPH requires a holistic assessment to distinguish the condition from other diseases with similar symptoms. A number of tests may be used in combination to diagnose NPH. These include:

  • General physical and neurological exam to evaluate symptoms
  • Computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain
  • Gait (walking) evaluation
  • Cognitive testing
  • Removal of CSF through a spinal tap (lumbar puncture) to see if brain functions temporarily improve

Early diagnosis of NPH increases a patient’s chances of successful treatment.

Normal Pressure Hydrocephalus Treatment

The most common method of treating NPH is to surgically insert a shunt, or catheter system, in the brain’s ventricle to continuously drain cerebrospinal fluid. The shunt bypasses any blockage at the meninges, allowing for a normal balance of CSF and brain tissue and the resumption of the cleansing function.

The shunt is typically directed from the brain through the neck and chest to the abdomen, where the fluid can be absorbed by the body. The shunt remains in place as long as the excess fluid is present.

Following the initial surgical procedure, the shunt is monitored regularly during follow-up visits to ensure that it is functioning properly.

Support Services for Normal Pressure Hydrocephalus

After the shunt is placed and working, we focus on rehabilitation and sustaining brain health. This can include physical therapy, exercise, and medications to treat bladder symptoms, aid the ability to walk , and control blood pressure, which may be particularly important for NPH patients.

Research for Normal Pressure Hydrocephalus

UT Southwestern is at the forefront of improving knowledge about NPH. We have developed a registry of data from our patients to enhance our understanding of the disease, with the hope of better diagnosing and treating it.