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Normal Pressure Hydrocephalus
Miral D. Jhaveri, MD, MBA
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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

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Capone PM et al: Neuroimaging of normal pressure hydrocephalus and hydrocephalus. Neurol Clin. 38(1):171-83, 2020
                                          2. Reeves BC et al: Glymphatic system impairment in Alzheimer's disease and idiopathic normal pressure hydrocephalus. Trends Mol Med. ePub, 2020
                                          3. Graff-Radford NR et al: Normal pressure hydrocephalus. Continuum (Minneap Minn). 25(1):165-86, 2019
                                          4. Isaacs AM et al: Current update on treatment strategies for idiopathic normal pressure hydrocephalus. Curr Treat Options Neurol. 21(12):65, 2019
                                          5. Liew BS et al: Current updates on idiopathic normal pressure hydrocephalus. Asian J Neurosurg. 14(3):648-56, 2019
                                          6. Skalick√Ĺ P et al: Normal pressure hydrocephalus-an overview of pathophysiological mechanisms and diagnostic procedures. Neurosurg Rev. ePub, 2019
                                          7. Bradley WG Jr: CSF Flow in the brain in the context of normal pressure hydrocephalus. AJNR Am J Neuroradiol. 36(5):831-8, 2015
                                          8. 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
                                          9. Ringstad G et al: Aqueductal stroke volume: comparisons with intracranial pressure scores in idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol. 36(9):1623-30, 2015
                                          10. 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
                                          11. Reddy GK et al: Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 81(2):404-10, 2014
                                          12. 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
                                          13. 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
                                          14. Williams MA et al: Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract. 3(5):375-85, 2013
                                          15. 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
                                          16. 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
                                          17. 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
                                          18. 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
                                          19. Shprecher D et al: Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 8(5):371-6, 2008
                                          20. 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
                                          21. Czosnyka M et al: Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg. 94(3):482-6, 2001
                                          22. Kizu O et al: Proton chemical shift imaging in normal pressure hydrocephalus. AJNR Am J Neuroradiol. 22(9):1659-64, 2001
                                          23. 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
                                          24. Parkkola RK et al: Cerebrospinal fluid flow in patients with dilated ventricles studied with MR imaging. Eur Radiol. 10(9):1442-6, 2000
                                          25. 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

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Capone PM et al: Neuroimaging of normal pressure hydrocephalus and hydrocephalus. Neurol Clin. 38(1):171-83, 2020
                                                                                  2. Reeves BC et al: Glymphatic system impairment in Alzheimer's disease and idiopathic normal pressure hydrocephalus. Trends Mol Med. ePub, 2020
                                                                                  3. Graff-Radford NR et al: Normal pressure hydrocephalus. Continuum (Minneap Minn). 25(1):165-86, 2019
                                                                                  4. Isaacs AM et al: Current update on treatment strategies for idiopathic normal pressure hydrocephalus. Curr Treat Options Neurol. 21(12):65, 2019
                                                                                  5. Liew BS et al: Current updates on idiopathic normal pressure hydrocephalus. Asian J Neurosurg. 14(3):648-56, 2019
                                                                                  6. Skalick√Ĺ P et al: Normal pressure hydrocephalus-an overview of pathophysiological mechanisms and diagnostic procedures. Neurosurg Rev. ePub, 2019
                                                                                  7. Bradley WG Jr: CSF Flow in the brain in the context of normal pressure hydrocephalus. AJNR Am J Neuroradiol. 36(5):831-8, 2015
                                                                                  8. 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
                                                                                  9. Ringstad G et al: Aqueductal stroke volume: comparisons with intracranial pressure scores in idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol. 36(9):1623-30, 2015
                                                                                  10. 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
                                                                                  11. Reddy GK et al: Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 81(2):404-10, 2014
                                                                                  12. 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
                                                                                  13. 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
                                                                                  14. Williams MA et al: Diagnosis and management of idiopathic normal-pressure hydrocephalus. Neurol Clin Pract. 3(5):375-85, 2013
                                                                                  15. 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
                                                                                  16. 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
                                                                                  17. 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
                                                                                  18. 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
                                                                                  19. Shprecher D et al: Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 8(5):371-6, 2008
                                                                                  20. 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
                                                                                  21. Czosnyka M et al: Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus. J Neurosurg. 94(3):482-6, 2001
                                                                                  22. Kizu O et al: Proton chemical shift imaging in normal pressure hydrocephalus. AJNR Am J Neuroradiol. 22(9):1659-64, 2001
                                                                                  23. 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
                                                                                  24. Parkkola RK et al: Cerebrospinal fluid flow in patients with dilated ventricles studied with MR imaging. Eur Radiol. 10(9):1442-6, 2000
                                                                                  25. 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