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Normal pressure hydrocephalus (NPH), also called malresorptive hydrocephalus, is a form of communicating hydrocephalus in which excess cerebrospinal fluid (CSF) builds up in the ventricles, leading to normal or slightly elevated cerebrospinal fluid pressure.
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury and at rest, is normally 7–15 mmHg for a supine adult. This equals to 9–20 cmH 2 O, which is a common scale used in lumbar punctures. [1]
Hydrocephalus ex vacuo from vascular dementia as seen on MRI. Normal pressure hydrocephalus (NPH) is a particular form of chronic communicating hydrocephalus, characterized by enlarged cerebral ventricles, with only intermittently elevated cerebrospinal fluid pressure. Characteristic triad of symptoms are; dementia, apraxic gait and urinary ...
When a patient has communicating hydrocephalus, the lateral ventricles and medial parts of the temporal lobes expand and compress the aqueduct. As a result, the pressure within the fourth ventricle drops and causes the aqueduct to close more tightly. This in effect could make aqueductal stenosis a byproduct of hydrocephalus. [8]
The current recommendation is to elevate the head of the bed to 30 degrees to optimize cerebral perfusion pressure and control the increase in intracranial pressure. [3] It is also worth noting that measures should be taken to reduce restrictive neck dressings or garments as these may lead to compression of the internal jugular veins and reduce ...
Occasionally, the CSF pressure measurement may be normal despite very suggestive symptoms. This may be attributable to the fact that CSF pressure may fluctuate over the course of the normal day. If the suspicion of problems remains high, it may be necessary to perform more long-term monitoring of the ICP by a pressure catheter.
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Normal pressure hydrocephalus (NPH) looks at CSF flow values and velocities, which is important for diagnosis because NPH is idiopathic and has varying symptoms amongst patients including urinary incontinence, dementia, and gait disturbances. Increased aqueduct CSF stroke volume and velocity are indicators of NPH. [7]