Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a disorder that affects the elderly, usually people above 60 years of age. It refers to increase in the volume of the fluid in the cavities of the brain with essentially the intracranial pressure being in the normal range. This is somewhat unusual, as normally when the cavities dilate due to excess fluid one would expect increase in the intracranial pressure.

The common triad of symptoms people present with are:

  1. Difficulty walking: People walk slowly and with short strides. Often describe as if their legs are glued to the floor. This can become severe and disabling and cause significant mobility problems.
  2. Decline in thinking: People find their thought process to be slow with impaired planning, concentration, decision making and with memory. In severe cases significant change in personality and memory that is not dissimilar to dementia.
  3. Loss of bladder control: This often presents as the advanced state of the disease.

Diagnosis of NPH is essentially based on the clinical presentation and the imaging that often shows enlarged cavities of the brain. In some instances, performing a lumbar puncture (using a needle to access the cerebrospinal fluid in the spine) and removing a large volume of fluid can transiently improve the symptom. This, although not always predictive, can indicate a good outcome after surgical treatment.

Surgical treatment usually involves using a ‘shunt’ to divert the excess fluid from the brain cavities to the abdominal cavity. This, in selected patients, can lead to significant improvement in the symptoms. Surgeons at Neurosurgery Tasmania use the most advanced shunting systems that can be programmed with a remote device to adjust the level of fluid diversion. This allows for fine-tuning the level of fluid diversion to achieve the optimum results