Abstract

Normal pressure hydrocephalus (NPH) is a neurological disorder characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the brain’s ventricles, leading to an enlarged cerebral ventricular system. Despite the term “normal pressure,” individuals with NPH often exhibit symptoms of increased intracranial pressure, including gait disturbances, cognitive decline, and urinary incontinence. This condition primarily affects older adults, with the average age of onset typically occurring in the sixth or seventh decade of life.

The hallmark clinical triad of NPH consists of gait disturbances, cognitive impairment, and urinary incontinence. Gait abnormalities manifest as a shuffling walk with short steps and difficulty maintaining balance. Cognitive decline may present as memory deficits, executive dysfunction, and overall impaired cognitive processing. Urinary incontinence often occurs later in the disease course and can contribute significantly to the patient’s overall functional decline. Diagnosis of NPH is challenging, and the condition is often underdiagnosed or misdiagnosed due to the overlap of symptoms with other neurological disorders, such as Parkinson’s disease or normal aging. The gold standard for diagnosis involves clinical evaluation, neuroimaging studies, and lumbar puncture. Imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, help assess ventricular enlargement and rule out other potential causes of the symptoms. The exact etiology of NPH remains elusive, and the condition is often considered idiopathic. However, several risk factors have been identified, including a history of subarachnoid hemorrhage, meningitis, or head trauma. Additionally, conditions such as Alzheimer’s disease and vascular dementia may contribute to the development or exacerbation of NPH symptoms. Treatment options for NPH primarily involve surgical interventions aimed at diverting or removing excess CSF. The most common surgical procedure is a ventriculoperitoneal shunt, which establishes a drainage pathway for CSF from the brain to the abdominal cavity, relieving intracranial pressure. Shunt surgery has shown varying degrees of success in improving symptoms, and careful patient selection is crucial for favorable outcomes.