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Normal Pressure Hydrocephalus
Miral D. Jhaveri, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Normal pressure hydrocephalus (NPH)
              • Synonyms

                • Idiopathic adult hydrocephalus syndrome
              • Definitions

                • Ventriculomegaly with normal CSF pressure, altered CSF dynamics

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Other Modality Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Bradley WG Jr: CSF Flow in the Brain in the Context of Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol. 36(5):831-838, 2015
                                              2. Hoza D et al: DTI-MRI biomarkers in the search for normal pressure hydrocephalus aetiology: a review. Neurosurg Rev. 38(2):239-44; discussion 244, 2015
                                              3. Ringstad G et al: Aqueductal Stroke Volume: Comparisons with Intracranial Pressure Scores in Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol. ePub, 2015
                                              4. Chotai S et al: External lumbar drain: A pragmatic test for prediction of shunt outcomes in idiopathic normal pressure hydrocephalus. Surg Neurol Int. 5:12, 2014
                                              5. Reddy GK et al: Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 81(2):404-10, 2014
                                              6. Torsnes L et al: Treatment and clinical outcome in patients with idiopathic normal pressure hydrocephalus--a systematic review. Dan Med J. 61(10):A4911, 2014
                                              7. Virhammar J et al: Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol. 35(12):2311-8, 2014
                                              8. Williams MA et al: Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract. 3(5):375-385, 2013
                                              9. Kim MJ et al: Differential diagnosis of idiopathic normal pressure hydrocephalus from other dementias using diffusion tensor imaging. AJNR Am J Neuroradiol. 32(8):1496-503, 2011
                                              10. Linninger AA et al: Normal and hydrocephalic brain dynamics: the role of reduced cerebrospinal fluid reabsorption in ventricular enlargement. Ann Biomed Eng. 37(7):1434-47, 2009
                                              11. Scollato A et al: Changes in aqueductal CSF stroke volume in shunted patients with idiopathic normal-pressure hydrocephalus. AJNR Am J Neuroradiol. 30(8):1580-6, 2009
                                              12. Woodworth GF et al: Cerebrospinal fluid drainage and dynamics in the diagnosis of normal pressure hydrocephalus. Neurosurgery. 64(5):919-25; discussion 925-6, 2009
                                              13. Shprecher D et al: Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 8(5):371-6, 2008
                                              14. Owler BK et al: Normal pressure hydrocephalus and cerebral blood flow: a PET study of baseline values. J Cereb Blood Flow Metab. 24(1):17-23, 2004
                                              15. Czosnyka M et al: Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg. 94(3):482-6, 2001
                                              16. Kizu O et al: Proton chemical shift imaging in normal pressure hydrocephalus. AJNR Am J Neuroradiol. 22(9):1659-64, 2001
                                              17. Tullberg M et al: Normal pressure hydrocephalus: vascular white matter changes on MR images must not exclude patients from shunt surgery. AJNR Am J Neuroradiol. 22(9):1665-73, 2001
                                              18. Parkkola RK et al: Cerebrospinal fluid flow in patients with dilated ventricles studied with MR imaging. Eur Radiol. 10(9):1442-6, 2000
                                              19. Bech RA et al: Frontal brain and leptomeningeal biopsy specimens correlated with cerebrospinal fluid outflow resistance and B-wave activity in patients suspected of normal-pressure hydrocephalus. Neurosurgery. 40(3):497-502, 1997
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Normal pressure hydrocephalus (NPH)
                                                          • Synonyms

                                                            • Idiopathic adult hydrocephalus syndrome
                                                          • Definitions

                                                            • Ventriculomegaly with normal CSF pressure, altered CSF dynamics

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Other Modality Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Bradley WG Jr: CSF Flow in the Brain in the Context of Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol. 36(5):831-838, 2015
                                                                                          2. Hoza D et al: DTI-MRI biomarkers in the search for normal pressure hydrocephalus aetiology: a review. Neurosurg Rev. 38(2):239-44; discussion 244, 2015
                                                                                          3. Ringstad G et al: Aqueductal Stroke Volume: Comparisons with Intracranial Pressure Scores in Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol. ePub, 2015
                                                                                          4. Chotai S et al: External lumbar drain: A pragmatic test for prediction of shunt outcomes in idiopathic normal pressure hydrocephalus. Surg Neurol Int. 5:12, 2014
                                                                                          5. Reddy GK et al: Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 81(2):404-10, 2014
                                                                                          6. Torsnes L et al: Treatment and clinical outcome in patients with idiopathic normal pressure hydrocephalus--a systematic review. Dan Med J. 61(10):A4911, 2014
                                                                                          7. Virhammar J et al: Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol. 35(12):2311-8, 2014
                                                                                          8. Williams MA et al: Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract. 3(5):375-385, 2013
                                                                                          9. Kim MJ et al: Differential diagnosis of idiopathic normal pressure hydrocephalus from other dementias using diffusion tensor imaging. AJNR Am J Neuroradiol. 32(8):1496-503, 2011
                                                                                          10. Linninger AA et al: Normal and hydrocephalic brain dynamics: the role of reduced cerebrospinal fluid reabsorption in ventricular enlargement. Ann Biomed Eng. 37(7):1434-47, 2009
                                                                                          11. Scollato A et al: Changes in aqueductal CSF stroke volume in shunted patients with idiopathic normal-pressure hydrocephalus. AJNR Am J Neuroradiol. 30(8):1580-6, 2009
                                                                                          12. Woodworth GF et al: Cerebrospinal fluid drainage and dynamics in the diagnosis of normal pressure hydrocephalus. Neurosurgery. 64(5):919-25; discussion 925-6, 2009
                                                                                          13. Shprecher D et al: Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 8(5):371-6, 2008
                                                                                          14. Owler BK et al: Normal pressure hydrocephalus and cerebral blood flow: a PET study of baseline values. J Cereb Blood Flow Metab. 24(1):17-23, 2004
                                                                                          15. Czosnyka M et al: Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg. 94(3):482-6, 2001
                                                                                          16. Kizu O et al: Proton chemical shift imaging in normal pressure hydrocephalus. AJNR Am J Neuroradiol. 22(9):1659-64, 2001
                                                                                          17. Tullberg M et al: Normal pressure hydrocephalus: vascular white matter changes on MR images must not exclude patients from shunt surgery. AJNR Am J Neuroradiol. 22(9):1665-73, 2001
                                                                                          18. Parkkola RK et al: Cerebrospinal fluid flow in patients with dilated ventricles studied with MR imaging. Eur Radiol. 10(9):1442-6, 2000
                                                                                          19. Bech RA et al: Frontal brain and leptomeningeal biopsy specimens correlated with cerebrospinal fluid outflow resistance and B-wave activity in patients suspected of normal-pressure hydrocephalus. Neurosurgery. 40(3):497-502, 1997