Normal-pressure Hydrocephalus: A Critical Review

Overview

Journal Dement Neuropsychol

Date 2019 Jul 10

PMID 31285787

Citations 46

Authors

Louise Makarem Oliveira

Ricardo Nitrini

Gustavo C Roman

Affiliations

Soon will be listed here.

Abstract

Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords "normal-pressure hydrocephalus" / "idiopathic normal-pressure hydrocephalus" / "secondary normal-pressure hydrocephalus" / "NPH" / "ventriculoperitoneal shunt". The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

Citing Articles

Unbiased CSF Proteomics in Patients With Idiopathic Normal Pressure Hydrocephalus to Identify Molecular Signatures and Candidate Biomarkers.

de Geus M, Wu C, Dodge H, Leslie S, Wang W, Lam T Neurology. 2025; 104(5):e213375.

PMID: 39951680 PMC: 11837848. DOI: 10.1212/WNL.0000000000213375.

Automated Detection of Normal Pressure Hydrocephalus Using CT Imaging for Calculating the Ventricle-to-Subarachnoid Volume Ratio.

Knittel J, Hoskin J, Hoyt D, Abdo J, Foldes E, McElvogue M AJNR Am J Neuroradiol. 2025; 46(1):141-146.

PMID: 39746816 PMC: 11735426. DOI: 10.3174/ajnr.A8451.

Association between telomere length and idiopathic normal pressure hydrocephalus: a Mendelian randomization study.

Yang F, Cai H, Ren Y, Huang K, Gao H, Qin L Front Neurol. 2025; 15:1393825.

PMID: 39741705 PMC: 11686450. DOI: 10.3389/fneur.2024.1393825.

Normal Pressure Hydrocephalus in Adult Mice Causes Gait Impairment, Cognitive Deficits, and Urinary Frequency with Incontinence.

Tish M, Voss N, Bertolli A, Klimara M, Smith R, Thedens D eNeuro. 2024; 11(11).

PMID: 39542734 PMC: 11595603. DOI: 10.1523/ENEURO.0412-24.2024.

Experience from a Fast-Track Multidisciplinary Clinic Integrating Movement Disorders Neurologists in Normal Pressure Hydrocephalus Evaluation.

Alhusaini S, Sine K, Prakash P, Korthauer L, Margolis S, Chen A J Clin Med. 2024; 13(20).

PMID: 39458085 PMC: 11509069. DOI: 10.3390/jcm13206135.

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