Normal Pressure Hydrocephalus (NPH)

Posted by e-Medical PPT Sunday, September 5, 2010
Normal pressure hydrocephalus (NPH) is a chronic type of communicating hydrocephalus in which the increase in intracranial pressure (ICP) due to accumulation of cerebrospinal fluid (CSF) becomes stable and that the formation of CSF equilibrates with absorption.There are 2 types of normal pressure hydrocephalus.Idiopathic form and secondary form which is due to subarachnoid haemorrhage, head injury, cranial surgery, or Meningitis.Although the exact mechanism is unknown,normal-pressure hydrocephalus is thought to be a form of communicating hydrocephalus with impaired CSF reabsorption at the arachnoid villi.Because of CSF equilibrates with absorption, patients do not exhibit the classic signs of increased intracranial pressure such as headache, nausea, vomiting, or altered consciousness.But patients do present with the classic triad(also known as Adam's triad) of gait difficulties, urinary incontinence, and mental decline.It is often misdiagnosed as Parkinson's disease, Alzheimer's disease, and senility due to its chronic nature and its presenting symptoms

* Gait disturbance and Ataxia is the first symptom of the triad and may be progressive, due to expansion of the ventricular system, particularly at the level of the lateral ventricles.NPH gait disturbance is often characterized as a magnetic gait, which may mimic a Parkinsonian gait but there is no rigidity or tremor.
* Dementia is predominantly frontal lobe in nature, with apathy, dullness in thinking, and slight inattention. Memory problems are usually the main problem, which can lead to the misdiagnosis of Alzheimer's disease.The dementia is thought to result from traction on frontal and limbic fibers that also run in the periventricular region.
* Urinary incontinence appears late in the illness, consisting of increased frequency and urgency. (frontal lobe incontinence)
NPH may be relieved by surgically implanting a ventriculoperitoneal shunt to drain excess cerebrospinal fluid to the abdomen where it is absorbed.

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