Normal-Pressure Hydrocephalus (NPH)

Normal-pressure hydrocephalus (NPH) is a condition in which too much cerebrospinal fluid (CSF) builds up in the brain. Unlike other types of hydrocephalus, NPH usually does not increase the pressure inside the skull. CSF normally cushions the brain and spinal cord, but when it collects in excess, it can interfere with how the brain works. NPH most often affects people over the age of 60. Because its symptoms resemble normal aging or other health problems, it can be difficult to diagnose.

Causes

NPH may occur when something blocks the normal flow of CSF. Possible causes include:

• Head injury.

• Brain infections.

• Bleeding inside the brain (stroke or ruptured vessel).

• In many cases, the cause is unknown.
  
  

Signs and Symptoms

NPH symptoms are often grouped into three main areas:

Walking problems (the most common symptom):

• Shuffling feet while walking.

• Feeling unsteady or imbalanced.

• Difficulty starting to walk after sitting.

• A sensation that the feet are “stuck to the floor.”

Thinking and memory changes:

• Forgetfulness.

• Trouble concentrating.

• Mood changes

• Confusion.

Bladder problems:

• Trouble controlling urination.
  
  

Diagnosis

Your provider may recommend:

• Medical history and physical exam – checking for walking changes, leg spasms, or unusual movements.

• Imaging tests – such as CT or MRI scans to look for fluid buildup.

• Lumbar puncture (spinal tap) – a needle is inserted into the lower back to remove CSF. Sometimes a special dye is used with imaging to see how CSF flows in the brain.
  
  

Treatment

• The most common treatment is surgery to place a shunt, a thin tube that drains extra CSF from the brain into another part of the body (usually the abdomen).

• In some cases, the shunt may be placed in the lower spine instead.

• After surgery, patients are closely monitored to ensure CSF is draining properly.

• If symptoms are mild, doctors may recommend regular monitoring before deciding on surgery.
  
  

Home Care

Medicines

• Take medicines exactly as prescribed.

• Avoid medicines that can affect thinking (such as strong painkillers or sleeping pills), unless approved by your doctor.

Lifestyle

• Do not smoke, vape, or use tobacco.

• Stay hydrated as recommended.

General instructions

• Work with your provider to plan for home safety and support.

• Ask when it is safe to return to normal activities such as work or school.

• Keep all follow-up appointments to monitor symptoms and treatment needs.
  
  

When to Call Your Healthcare Provider

Contact your doctor if:

• You notice new or worsening symptoms.

• Walking and balance problems increase.

• Bladder problems become worse.

• You or your family are concerned about your safety or increasing confusion.

When to Get Emergency Help

Call local emergency services right away if you:

• Have a seizure (twitching or shaking).

• Develop a fever or signs of infection.

• Have severe headaches.

• Notice blurred vision, especially in the morning.

• Have increasing sleepiness or difficulty staying awake.

Do not wait for symptoms to improve, and do not drive yourself to the hospital.

Summary

• Normal-pressure hydrocephalus (NPH) is caused by a buildup of CSF in the brain.

• It can lead to walking problems, memory and thinking issues, and bladder control difficulties.

• Diagnosis often requires brain imaging and lumbar puncture.

• Treatment usually involves surgical placement of a shunt.

• Regular follow-up and monitoring are essential.
  
  

Note: This information is for education only and does not replace medical advice. Always discuss your symptoms and treatment options with your healthcare provider.