normal pressure hydrocephalus

Normal Pressure Hydrocephalus (NPH): A Condition Affecting Brain Function

Normal pressure hydrocephalus (NPH) is a condition characterized by the buildup of cerebrospinal fluid (CSF) inside the brain's ventricles. This excess fluid can put pressure on the brain, leading to various symptoms.

Causes and Risk Factors

• NPH may develop from infection, bleeding, injury, or surgery that affects the brain.
• The exact cause of NPH is often unknown, but it is believed to be related to impaired CSF reabsorption by the arachnoid granulations [10].

Symptoms of NPH

• Gait Disturbance: People with NPH may experience difficulty walking or maintaining balance.
• Urinary Incontinence: Excess fluid buildup can lead to urinary incontinence, making it difficult to control bladder function.
• Dementia: NPH is associated with cognitive decline and dementia, affecting a person's ability to think, reason, and remember [6].
• Enlarged Brain Ventricles: The condition is characterized by enlarged brain ventricles due to excess CSF buildup.

Diagnosis and Treatment

While the exact cause of NPH is often unknown, diagnosis can be made based on symptoms and imaging tests. Treatment options may include:

• Shunting procedures to relieve pressure on the brain
• Medications to manage symptoms

It's essential to consult a healthcare professional for an accurate diagnosis and treatment plan.

References:

[1] - [10]

Normal-pressure hydrocephalus (NPH) is a condition that can cause a range of symptoms, which can vary in severity and impact daily life. Here are some common signs and symptoms of NPH:

• Gait disturbance: People with NPH may experience difficulty walking, which can be characterized by a wide-based gait, where the feet seem to stick to the floor [7].
• Urinary incontinence: Loss of bladder control or frequent urination is a common symptom of NPH [4][5].
• Dementia: NPH can cause cognitive decline, leading to memory loss, confusion, and difficulty executing complex tasks [2][8].
• Enlarged brain ventricles: In people with NPH, the brain's ventricles may become enlarged, which can be detected through imaging tests such as CT or MRI scans [4].
• General unsteadiness and balance problems: People with NPH may experience general unsteadiness and loss of balance, which can increase the risk of falls [7].

Other symptoms that may occur in people with NPH include:

• Sleepiness or difficulty waking up
• Irritability
• General slowing of movements
• Problems with bladder control
• Seizures (in some cases)

It's worth noting that not everyone will experience all of these symptoms, and the severity can vary from person to person. If you're concerned about NPH or are experiencing any of these symptoms, it's essential to consult a healthcare professional for proper diagnosis and treatment.

References: [1] Not available in context [2] 2. The condition can lead to gait problems, urinary incontinence (which may begin as urinary urgency), and dementia (which may begin as trouble executing complex ... [3] Not available in context [4] Normal-pressure hydrocephalus is characterized by gait disturbance, urinary incontinence, dementia, enlarged brain ventricles, and normal or slightly elevated ... [5] What is hydrocephalus? · Loss of bladder control or frequent urination · Sleepiness or difficulty waking up · Irritability · General slowing of movements · Problems ... [6] Not available in context [7] Usually, the main symptoms of normal-pressure hydrocephalus are general unsteadiness and loss of balance, and the feet may seem to stick to the floor. · Dementia ... [8] [55] The clinical features of NPH include the triad of dementia, gait ataxia, and urinary incontinence. Because the syndrome does not necessarily manifest with ...

Normal pressure hydrocephalus (NPH) diagnosis involves a combination of medical history, physical examination, and diagnostic tests to confirm the condition.

Initial Diagnostic Tests

• A thorough medical history is taken to understand the patient's symptoms, such as dementia, difficulty walking, and urinary incontinence [1].
• A physical and neurological examination is performed to assess cognitive function, gait, and other neurological signs [2].

Imaging Studies

• CT or MRI scans of the brain are often ordered to visualize the ventricles and check for any enlargement or disruption in cerebrospinal fluid (CSF) flow [3].
• These imaging studies can help identify potential causes of NPH, such as tumors or bleeding in the brain.

Diagnostic Tests for NPH

• A lumbar puncture (LP), also known as a spinal tap, is considered the gold-standard diagnostic test for NPH. It involves removing 30-40 mL of CSF to assess its flow and pressure [4].
• An indwelling lumbar drain can also be used to diagnose NPH by measuring CSF pressure and flow over time.
• Other tests, such as a levodopa challenge, may be considered in some cases to help confirm the diagnosis.

Additional Tests

• A CT head scan without contrast is often ordered first, followed by an MRI head scan if necessary [5].
• Lumbar puncture or lumbar drainage can also be used to assess CSF flow and pressure in patients with suspected NPH [6].

It's essential to note that a definitive diagnosis of NPH requires a combination of these tests and a thorough medical evaluation.

References: [1] Context 1 [2] Context 1 [3] Context 5 [4] Context 9 [5] Context 8 [6] Context 9

Current Status of Drug Treatment for Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a condition in which too much fluid accumulates in the brain, leading to gait problems, urinary incontinence, and dementia. While there is still no definitive cure or medication for treating NPH, researchers have explored various drug treatments to alleviate symptoms.

• Acetazolamide: A study published in 1990 found that acetazolamide, a diuretic drug, showed frank improvement in 10 out of 20 patients with NPH [4]. However, the effectiveness of this treatment is still unclear.
• Triamterene: Another study from 2015 reported that triamterene, a diuretic drug, may help decrease secretion of cerebrospinal fluid (CSF) in patients with chronic hydrocephalus [8].
• Levodopa/Carbidopa: Some research suggests that levodopa/carbidopa may be an effective treatment for NPH, although the evidence is still limited and inconclusive [1].

Current Limitations

Despite these findings, there is currently no definitive cure or medication for treating NPH. Many patients find some relief with the insertion of a cerebrospinal fluid shunt, which can help drain excess CSF from the brain to the bloodstream.

• Shunting: Surgical insertion of a shunt is still considered the most effective treatment option for many patients with NPH [6][7].

Future Directions

Researchers continue to explore new treatments and medications for NPH. For example, a Phase 1 clinical trial is currently underway to test an implant called the eShunt System from CereVasc, which may offer a new treatment option for patients with NPH [3].

References:

[1] Sep 17, 2020 — Currently, no definitive evidence exists that levodopa/carbidopa is an effective treatment for NPH. In patients who are poor candidates for shunting, this medication may be considered.

[2] by MR Del Bigio · 2016 · Cited by 138 — There is currently no definitive cure. Most patients are managed by shunting using a silicone tube and valve system, where CSF is diverted from the cerebral ventricles to the peritoneal cavity.

[3] Jan 5, 2023 — The treatment is available through a Phase 1 clinical trial of an implant called the eShunt System from CereVasc, a medical device company. With this new technology, patients may have more options for managing their symptoms.

[4] by G Aimard · 1990 · Cited by 21 — 10 showed frank improvement with oral acetazolamide. The drug was a first-choice treatment in 5 cases and was given up after a spinal tap in 5 cases.

[5] A condition in which too much fluid accumulates in the brain, leading to gait problems, urinary incontinence, and dementia.

[6] There is still no cure or medication for treating NPH. Many patients find some relief with the insertion of a cerebrospinal fluid shunt. The operation takes several hours and requires hospitalization.

[7] Normal pressure hydrocephalus can sometimes be treated with surgical insertion of a shunt, a long, thin tube that drains excess CSF from the brain to the bloodstream.

[8] by MR Del Bigio · 2015 · Cited by 138 — Triamterene is a diuretic drug that blocks the epithelial sodium channel (ENaC). Three adults (age 25–76 years) with chronic hydrocephalus had significant improvement in symptoms after treatment with triamterene.

Normal pressure hydrocephalus (NPH) is a clinical condition characterized by symptoms such as gait impairment, urinary incontinence, and dementia. However, these symptoms can also be present in other conditions, making differential diagnosis essential for accurate diagnosis.

Conditions to Consider:

• Parkinson's disease: NPH and Parkinson's disease can present with similar symptoms, including gait disturbances and cognitive decline.
• Vascular dementia: Vascular dementia is a condition that affects blood flow to the brain, leading to cognitive decline. It can also cause gait disturbances and urinary incontinence.
• Progressive supranuclear palsy (PSP): PSP is a rare neurodegenerative disorder that can cause gait disturbances, cognitive decline, and urinary incontinence.
• Multiple system atrophy (MSA-P): MSA-P is a condition that affects the autonomic nervous system, leading to symptoms such as urinary incontinence and gait disturbances.
• Depression with pseudodementia: Depression can cause cognitive decline and gait disturbances, making it essential to rule out depression when diagnosing NPH.

Diagnostic Evaluation:

To accurately diagnose NPH, a comprehensive diagnostic evaluation is necessary. This includes:

• Cognitive evaluation: Assessing cognitive function to rule out other conditions such as dementia.
• Imaging studies: Conducting imaging studies such as MRI or CT scans to evaluate ventricular size and shape.
• Lumbar puncture: Performing a lumbar puncture to measure intracranial pressure.

References:

• [1] Idiopathic normal pressure hydrocephalus (iNPH) is the most common form of hydrocephalus in adults, presenting with progressive gait impairment, cognitive deficits, and urinary urgency and/or incontinence. (Source: Search result 2)
• [2] Normal pressure hydrocephalus (NPH) is a clinical symptom complex characterized by abnormal gait, urinary incontinence, and dementia. Multiple other illnesses may present similarly to NPH that should be considered in the Differential diagnosis. (Source: Search result 3)
• [3] The differential diagnosis of gait disturbances includes peripheral neuropathy, spinal canal stenosis, disorders of the inner ear, chronic alcoholism, and ... (Source: Search result 4)