Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a progressive neurological condition that occurs when cerebrospinal fluid (CSF) accumulates in the brain. There is no cure or medications available to treat NPH, but many patients can find relief with surgical treatment.

Symptoms of NPH

CSF is naturally occurring in the brain, but when too much accumulates, it puts pressure on the brain, which can cause symptoms such as:

  • Confusion
  • Changes in one’s mood/depression
  • Difficulty with balance
  • Difficulty walking
  • Difficulty answering questions.
  • Difficulty in bladder control

These symptoms can negatively impact a person’s quality of life and make everyday tasks more difficult.

Assessment and Diagnosis

At UConn Health, the process for the assessment and diagnosis of NPH includes experts from many specialties and subspecialties, such as neurology, neurosurgery, imaging, neuropsychology, urology, and geriatrics.

After an initial appointment with one of our neurologists, if NPH is suspected, you will undergo further testing that may include neuropsychological testing, neuroradiology, and a urology assessment. These tests help to create a complete picture of your condition. A multidisciplinary team of experienced NPH practitioners will then meet to discuss your case.

Large Volume Lumbar Puncture

If the team agrees that the symptoms and testing may indicate NPH, the next step is a large-volume lumbar puncture. This procedure is a lumbar puncture that extracts a large volume of CSF. The procedure will aid in the assessment of NPH and may also relieve some of the symptoms of NPH. The large-volume lumbar puncture is an outpatient procedure, and most patients can return home in a few hours.

Once we have the results from the lumbar puncture, the multidisciplinary team will meet again to discuss the findings and decide on the best way to proceed with your case.

Treating NPH With Shunt Surgery

If the team concludes that you have NPH, you will then see a neurosurgeon to discuss treating your condition with shunt surgery. During shunt surgery, a flexible plastic tube called a shunt will be inserted into your body. One end goes into the brain and the other into the abdomen, so the excess of CSF can drain down the shunt and into your abdomen, relieving your symptoms of NPH.

Post-surgery, you will then be assessed at 2 weeks, 6 weeks, 3 months, 6 months, and a year to ensure that the shunt is working correctly and the symptoms of NPH have not returned.

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