What is Hydrocephalus?
Hydrocephalus is a condition in which there is an abnormal buildup of cerebrospinal fluid (CSF) within the brain’s ventricles (fluid-filled spaces).
This buildup can lead to enlargement of the ventricles and may affect brain function.
One important and often underdiagnosed type is Normal Pressure Hydrocephalus (NPH), which typically affects older adults and can present more subtly than other forms of hydrocephalus.
What is Normal Pressure Hydrocephalus (NPH)?
In normal pressure hydrocephalus, the ventricles are enlarged, but overall pressure readings may appear normal. Despite this, the abnormal CSF dynamics can still lead to significant symptoms.
NPH is important to recognize because it is one of the few reversible causes of cognitive and functional decline when properly diagnosed and treated.
Symptoms of NPH
NPH is classically associated with a triad of symptoms:
- Gait difficulty (often the earliest and most prominent symptom; patients may feel “magnetic” or unsteady)
- Cognitive changes (memory issues, slowed thinking)
- Urinary incontinence
Not all patients have all three symptoms, and presentation can vary.
Why Diagnosis Requires a Comprehensive Workup
Diagnosing NPH can be challenging because symptoms often overlap with other conditions such as:
- Parkinson’s disease
- Alzheimer’s disease
- General age-related changes
For this reason, a thorough and multidisciplinary evaluation is essential.
At our practice, we coordinate closely with:
- Interventional radiology
- Physical therapy
- Neuropsychology
This team-based approach allows us to carefully assess both objective and subjective changes during the diagnostic process.
High-Volume Lumbar Puncture (Tap Test)
A key part of the evaluation is a high-volume lumbar puncture, where a significant amount of cerebrospinal fluid is removed.
Before and after the procedure, patients undergo functional assessment, including:
- Gait testing, often using tools such as the Tinetti score
- Clinical evaluation of balance and mobility
- Assessment of cognitive or subjective improvement
If a patient demonstrates meaningful improvement—both objectively (e.g., gait metrics) and subjectively—this suggests they may benefit from surgical treatment.
Treatment: Ventriculoperitoneal (VP) Shunt
For patients who respond to the lumbar puncture trial, the standard treatment is placement of a ventriculoperitoneal (VP) shunt.
A VP shunt is a small, internal device that:
- Diverts excess cerebrospinal fluid from the brain
- Drains it into the abdominal cavity, where it can be absorbed
This helps restore more normal CSF dynamics and can lead to improvement in walking, cognition, and bladder control.
Our Approach
We emphasize accurate diagnosis and careful patient selection, as outcomes depend heavily on identifying the right candidates for treatment.
Through a coordinated, multidisciplinary workup, we ensure that each patient is thoroughly evaluated before proceeding with intervention.
When a VP shunt is indicated, we utilize modern shunt systems and refined surgical techniques to optimize outcomes while minimizing risks.
View the approach