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Normal pressure hydrocephalus

Normal Pressure Hydrocephalus, NPH for short, is a much under-recognised treatable brain disorder that affects older people of 60 years plus.

What is normal pressure hydrocephalus?

The ventricles, which are hollow chambers in the brain, typically hold fluid. Cerebrospinal fluid (CSF) is the term for this substance. The brain and spinal cord are cushioned by it. Normal daily CSF production and absorption by the body are equal. However, the ventricles occasionally experience a buildup of excess fluid. This can lead to normal pressure hydrocephalus (NPH).

Walking difficulties, difficulty thinking, or loss of bladder control may indicate NPH.

Early diagnosis may prevent long-term problems.

What causes normal pressure hydrocephalus?

An injury, bleeding, infection, brain tumor, or brain surgery could be the cause of the buildup of fluid in the ventricles of the brain. The cause, though, is frequently unknown. The ventricles enlarge and press against nearby brain tissue when extra fluid accumulates there. Damage to the brain may result from this added fluid and pressure.

NPH though rare, most often affects older adults, and its symptoms can be similar to those of Alzheimer's and Parkinson's diseases. A healthcare provider familiar with these conditions can often tell the difference between these diseases and NPH after special testing.

Initial symptoms may start off as a feeling of unsteadiness, particularly when changing direction or going up or down stairs. As symptoms progress, walking further deteriorates, with slowing and shuffling and a feeling that the feet are stuck to the floor and won't move as told. Bladder control can worsen with a need to rush to the bathroom (known as urinary urgency), which can develop into incontinence.

Progressive memory problems may develop along with difficulty multitasking and using technological devices such as smartphones or computers. The symptoms are often attributed to 'old age' and NPH is often overlooked as a possible cause.

Trouble walking (feels like the feet are stuck to the ground).

Poor balance.


Changes in the way you walk.

Forgetfulness and confusion.

Mood changes.


Difficulty responding to questions.

Loss of bladder control.

Your consultant may need to do a number of tests to confirm NPH, such as:

Physical exam and review of your symptoms.

A comprehensive evaluation including walking, balance and memory testing.

Confirmatory diagnostic procedure to drain cerebrospinal fluid to assess responsiveness.

A commonly used treatment for NPH is surgery to place a tube, called a shunt, into the brain to drain the excess fluid. The shunt is usually inserted into a ventricle in the brain and then passed under your skin from your head through your neck and chest to your abdomen. The extra fluid in your brain flows through the shunt into your abdomen, where your body absorbs it. The ventricles in your brain may then return to their normal size. The shunt stays in place as long as there is too much CSF in the brain.

Implanting a shunt doesn’t work for everyone, but some people do benefit from it. Getting prompt diagnosis and treatment helps improve your chances of a positive outcome.

Treatment Overview

Combining a calming hospital environment with outstanding patient care so you can recover as quickly as possible.

  • Typical hospital stay 1 - 2 days

  • Type of anaesthetic General

  • Can I pay privately? Yes

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