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NORMAL PRESSURE HYDROCEPHALUS

Neurology

NORMAL PRESSURE HYDROCEPHALUS

1. Reversible cause of dementia characterised by communicating hydrocephalus & no cerebral atrophy.

2. NPH often occurs after head trauma, meningitis, or SAH and a history of 1 of these premorbid conditions appears to be the best predictor of a beneficial response to shunting.

3. Normal ICP & no papilledema. Presents with classic Hakim's triad: progressive dementia, urinary incontinence, gait ataxia (a "magnetic" gait, with the feet appearing glued to the floor).

4. Certain tests may help to identify patients who are most likely to respond to shunting: response to LP, isotope cystemography, and dynamic MRI, which measures the direction of CSF flow (but none of these tests is universally reliable).

5. Treatment is VP shunt insertion.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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