NORMAL PRESSURE HYDROCEPHALUS

This condition was first described in 1965 by Adams and Hakim as a new entity in patients that showed a characteristic triad of cognitive impairment, gait disturbance and urinary incontinence, with ventricular enlargement and normal intracranial pressure.

The use of a shunt valve in selected patients improves clinical symptoms.

This condition is diagnosed based on clinical symptoms and confirmed by radiologic procedures. NPH, which may be wrongly diagnosed as Dementia or Alzheimer’s Disease,
may develop as a secondary condition and a late complication of cranioencephalic trauma, CNS infections and subarachnoid hemorrhage; however, in a large number of cases there is no history at all.

Normal pressure is not an adequate term as some patients who undergo intracranial pressure monitoring show intermittent pressure increases, usually during the night. Gait disturbance may be mistaken for Parkinson’s disease.

Main Features:
• Classic triad: dementia, gait disturbance and urinary incontinence
• Communicating hydrocephalus is observed in CT scan or MRI
• Pressure is normal in random LP.
• Symptoms may resolve by performing a CSF shunt.

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