Normal pressure hydrocephalus - Revision history

Aidan: /* Investigations */

2026-03-07T14:52:39Z

Investigations

← Older revision		Revision as of 14:52, 7 March 2026
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	* Should have normal CBC, lytes, creatinine, vit B12, TSH, calcium		* Should have normal CBC, lytes, creatinine, vit B12, TSH, calcium
	* CT head showing hydrocephalus		* CT head showing hydrocephalus; MRI can also be helpful
	* Lumbar puncture confirming normal pressure		* Lumbar puncture confirming normal pressure
	** CSF glucose and protein are typically normal		** CSF glucose and protein are typically normal
	* High-volume lumbar puncture (30 to 50 mL)		** High-volume lumbar puncture (remove 30 to 50 mL of CSF)
	** Observe for improvement, particularly in gait		*** Observe for improvement, particularly in gait
	** Can use objective measures like a [[timed up and go test]], where 5 seconds improvement is considered supportive		*** Can use objective measures like a [[timed up and go test]], where 5 seconds improvement is considered supportive

	== Grading ==		== Grading ==

Aidan: /* Management */

2026-03-07T14:51:54Z

Management

← Older revision		Revision as of 14:51, 7 March 2026
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	* Lumbar puncture confirming normal pressure		* Lumbar puncture confirming normal pressure
	** CSF glucose and protein are typically normal		** CSF glucose and protein are typically normal
			* High-volume lumbar puncture (30 to 50 mL)
		⚫	** Observe for improvement, particularly in gait
			** Can use objective measures like a [[timed up and go test]], where 5 seconds improvement is considered supportive

	== Grading ==		== Grading ==
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	== Management ==		== Management ==

	* ~~High~~-volume lumbar puncture ~~(30~~ to 50 ~~mL)~~		* If there is improvement in symptoms after large-volume lumbar puncture, consider implanting a ventriculoperitoneal shunt
⚫	** Observe for improvement, particularly in gait
	** If there is improvement in symptoms, consider implanting a ventriculoperitoneal shunt

	[[Category:Neurology]]		[[Category:Neurology]]

Aidan at 14:49, 7 March 2026

2026-03-07T14:49:57Z

@@ Line 8: / Line 8: @@
 * &quot;Wobbly, wet, and wacky&quot;
 * Earliest symptoms is gait instability/apraxia (&quot;magnetic gait&quot;) progressing over months to years
 * Next is dementia
-** Cognitive symptoms include psychomotor slowing, decreased attention/concentration, impaired executive function, and apathy
+** Cognitive symptoms include psychomotor slowing, forgetfulness, decreased attention/concentration, impaired executive function
 * Usually last symptom is urinary incontinence, in about 50% of patients at diagnosis
 ** First as urgency with an inability to reach the bathroom in time, then later progressing to incontinence with apathy
@@ Line 30: / Line 34: @@
 * Lumbar puncture confirming normal pressure
 ** CSF glucose and protein are typically normal
 == Management ==
 * High-volume lumbar puncture (30 to 50 mL)
 ** If there is improvement in symptoms, consider implanting a ventriculoperitoneal shunt

Aidan at 14:44, 7 March 2026

2026-03-07T14:44:51Z

← Older revision		Revision as of 14:44, 7 March 2026
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	* "Wobbly, wet, and wacky"		* "Wobbly, wet, and wacky"
	* ~~Presents~~ ~~with~~ gait instability/apraxia ("magnetic gait") progressing over months to years~~, followed by dementia~~		* Earliest symptoms is gait instability/apraxia ("magnetic gait") progressing over months to years
			* Next is dementia
	** Cognitive symptoms include psychomotor slowing, decreased attention/concentration, impaired executive function, and apathy		** Cognitive symptoms include psychomotor slowing, decreased attention/concentration, impaired executive function, and apathy
			* Usually last symptom is urinary incontinence, in about 50% of patients at diagnosis
	* ~~Urinary incontinence is common, presenting first~~ as urgency with an inability to reach the bathroom in time, then later progressing to incontinence with apathy		** First as urgency with an inability to reach the bathroom in time, then later progressing to incontinence with apathy
	* There should be ''no'' headaches, nausea/vomiting, visual changes, or [[papilledema]]		* There should be ''no'' headaches, nausea/vomiting, visual changes, or [[papilledema]]

Aidan at 14:24, 7 March 2026

2026-03-07T14:24:18Z

← Older revision		Revision as of 14:24, 7 March 2026
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			== Background ==

			* May be idiopathic (mostly the focus here) or secondary (to prior infection, ICH, TBI, or radiation)
			* Idiopathic is more common in older patients and is somewhat a disease of aging

	== Clinical Manifestations ==		== Clinical Manifestations ==

Aidan: /* Clinical Manifestations */

2026-03-07T14:15:48Z

Clinical Manifestations

← Older revision		Revision as of 14:15, 7 March 2026
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	** Cognitive symptoms include psychomotor slowing, decreased attention/concentration, impaired executive function, and apathy		** Cognitive symptoms include psychomotor slowing, decreased attention/concentration, impaired executive function, and apathy
	* Urinary incontinence is common, presenting first as urgency with an inability to reach the bathroom in time, then later progressing to incontinence with apathy		* Urinary incontinence is common, presenting first as urgency with an inability to reach the bathroom in time, then later progressing to incontinence with apathy
	* There should be ''no'' headaches, nausea/vomiting, visual changes, or papilledema		* There should be ''no'' headaches, nausea/vomiting, visual changes, or [[papilledema]]

	== Differential Diagnosis ==		== Differential Diagnosis ==

Aidan at 19:31, 24 July 2025

2025-07-24T19:31:22Z

@@ Line 1: / Line 1: @@
 == Clinical Manifestations ==
@@ Line 16: / Line 6: @@
 * Urinary incontinence is common, presenting first as urgency with an inability to reach the bathroom in time, then later progressing to incontinence with apathy
 * There should be ''no'' headaches, nausea/vomiting, visual changes, or papilledema
 == Investigations ==
@@ Line 22: / Line 22: @@
 * CT head showing hydrocephalus
 * Lumbar puncture confirming normal pressure
 == Management ==

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-22T02:07:59Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 02:07, 22 July 2020
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	* Vascular dementia		* Vascular dementia

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* "Wobbly, wet, and wacky"		* "Wobbly, wet, and wacky"

Maintenance script: Imported from text file

2020-07-04T01:17:47Z

Imported from text file

New page

== Differential Diagnosis ==

* Dementia with Lewy bodies
* Parkinson disease dementia
* Progressive supranuclear palsy
* Multiple system atrophy
* Corticobasal syndrome
* Alzheimer disease
* Vascular dementia

== Clinical Presentation ==

* "Wobbly, wet, and wacky"
* Presents with gait instability/apraxia ("magnetic gait") progressing over months to years, followed by dementia
** Cognitive symptoms include psychomotor slowing, decreased attention/concentration, impaired executive function, and apathy
* Urinary incontinence is common, presenting first as urgency with an inability to reach the bathroom in time, then later progressing to incontinence with apathy
* There should be ''no'' headaches, nausea/vomiting, visual changes, or papilledema

== Investigations ==

* Should have normal CBC, lytes, creatinine, vit B12, TSH, calcium
* CT head showing hydrocephalus
* Lumbar puncture confirming normal pressure

== Management ==

* High-volume lumbar puncture (30 to 50 mL)
** If there is improvement in symptoms, consider implanting a ventriculoperitoneal shunt

[[Category:Neurology]]