What is normal pressure hydrocephalus?
Normal pressure hydrocephalus (NPH) is a condition where fluid builds up inside spaces of the brain called ventricles. This fluid, known as cerebrospinal fluid, usually protects and cushions the brain. When too much collects, it can press on nearby brain tissue and affect how the brain works.
NPH most often affects older adults and can sometimes be mistaken for other conditions that impact memory and movement.
Symptoms and Causes
NPH symptoms often develop slowly and may be mistaken for normal aging or other neurological conditions. The most common signs affect movement, thinking, and bladder control.
Symptoms may include:
- Difficulty walking or a shuffling gait
- Trouble with balance or frequent falls
- Memory problems or confusion
- Slower thinking or delayed responses
- Mood changes, including depression
- Loss of bladder control
NPH can happen without a clear cause, but it may also be linked to:
- Previous head injury
- Brain infections
- Bleeding in the brain
- Brain tumors
- Past brain surgery
How is it diagnosed?
Diagnosing NPH involves evaluating your symptoms, along with imaging and specialized testing. Your provider will review your medical history and evaluate your walking and thinking.
Common tests include:
- MRI or CT scans to look at the brain structure
- A spinal tap to measure and remove fluid
- Short-term fluid drainage to see if symptoms improve
These steps help determine if NPH is the cause and whether treatment may help.
How is it treated?
Treatment focuses on reducing the extra fluid in the brain. The most common approach is surgery to place a small tube called a shunt.
- The shunt moves excess fluid from the brain to another part of the body, usually the abdomen
- The body then absorbs the fluid naturally
- The device stays in place to manage fluid levels over time
Not everyone responds the same way to treatment, but many people see improvement—especially in walking. Getting care early can make a meaningful difference in recovery.
