Normal pressure hydrocephalus
From IDWiki
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
- "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
Differential Diagnosis
- Dementia with Lewy bodies
- Parkinson disease dementia
- Progressive supranuclear palsy
- Multiple system atrophy
- Corticobasal syndrome
- Alzheimer disease
- Vascular dementia
Investigations
- Should have normal CBC, lytes, creatinine, vit B12, TSH, calcium
- CT head showing hydrocephalus
- 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
