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February 26, 2015 / Mark Kerrigan

What are the Symptoms of Normal Pressure Hydrocephalus


Hydrocephalus_ribbon_two_tone_blue_jpgBeing a full-time caregiver, I have clients who have suffered many different afflictions of the brain. One particular client I have is diagnosed with Normal Pressure Hydrocephalus. Unfamiliar with this condition, I contacted the Hydrocephalus Support Group in Seattle, Wash. for more information about it. Thanks to Diana for sending me an informative email.

What is Normal Pressure Hydrocephalus?

The build up of cerebral spinal fluid (CSF) puts pressure on the brain itself, causing damage. CSF is there to cushion and protect the brain and spinal cord  from minor bumps and shakes. The CSF moves around the brain in ventricles, pockets around the brain, supplying nutrients and removing waste products through the veins in the head.MBq_Hydrocephalus

Hydrocephalus is a condition in which there is too much CSF in the ventricles. This occurs when the natural system for draining and absorbing extra CSF does not work right. The ventricles enlarge to accommodate the extra fluid and then press on different parts of the brain.” The inside of the cranium is not smooth like the outside we have all seen in science class. There are crags and fairly sharp points which can cause serious damage if the brain is slammed or pushed into them by some outside force.

NPH usually occurs in older adults when a blockage occurs preventing the CSF from being removed. Gradually the ventricles enlarge, giving space for the excess CSF. This is why the symptoms of NPH occur gradually, unlike with other TBIs where there is a clear loss of function or ability. The term “normal pressure” is somewhat misleading.

The damage inflicted by the protrusions of the indside of the skull differs from person to person.  Therefore, a neurologist would need to be contacted to determine what damage had been caused on a case-by-case basis.

What are the Symptoms of NPH?

Untreated/unmanaged hydrocephalus (NPH or any of the other types of the condition) causes damage to the brain itself.  In some cases that damage can go so far as to cause death.Some of the symptoms of NPH include a shuffling gait and downcast (sunset) eyes, confusion & headaches (sometimes with light or sound sensitivity).  Often the sound + light sensitivity are thought to be migraines, but that can also be a symptom of what we call a fluid headache.

Some of the other symptoms include those commonly associated with dimentias, including symptoms of Alzheimer’s & Parkinson’s, which is why 10-15 percent of cases are first midiagnosed as any of these, before proper diagnosis is made.  That can leave the person significantly compromised unnecessarily, since the damage is most often permanent.

Most often hydrocephalus affects the legs, the bladder and higher “cognitive” functions, such as reasoning, problem solving, memory and speaking. Most of the time, NPH causes loss of control of the bladder, causing urinary incontinence, and occasionally the bowels.

Is there Any Treatment for NPH?

Often, one of the best ways to manage NPH is to place a shunt (a drain from the head removing the excessive Cerebral Spinal Fluid

There is also a lot fear surrounding hydrocephalus, whatever the type is that a patient has.  The fear of having a shunt (the shunt doesn’t go into the brain itself, it goes into the area around the brain where the cerebral spinal fluid (csf) resides.  The shunt simply drains excess fluid to maintain a healthy pressure level. Although the placing of a shunt can alleviate many of the symptoms, surgery can often induce anxiety and a sense of panic–especially when it involves the brain.

What are Common Misconceptions about NPH?

There are many myths surrounding hydrocephalus–no matter whether it is managed or unmanaged.640px-Subarachnoid_haemorrhage

  • Some think that their head is going to explode.  Not going to happen.  Some think that they are going to lose their minds.  Not going to happen–especially with early treatment. Anyone who has experienced allergies and has had a sinus headache has felt like this. In neither case will the person’s head explode.
  • There is also a myth that hydrocephalus means that there is a loss of a quality of life, which doesn’t necessarily have to be the case.  Especially with today’s drugs and proper management, Hydrocephalus, including NPH, is a very treatable, manageable condition, especially if found early. My cleint enjoys seeing his grandchildren and performs the typical activities a normal 85 year old man does. He has a sharp wit most of the time, and his family says he’s as stubborn as he ever was. So the quality of life does not change dramatically and the patient maintains many of his characteristics from earlier in life. Unfortunately, this is not the case for many traumatic brain injuries (TBIs). I personally know that I experienced a total personality shift after my car wreck. Prior to it, I was shy, almost introverted. Immediately after, I developed traits of being a “people person” and felt at home in a crowd although I was often distracted.
  • There is also the myth that one has to live in fear, at home, behind closed doors.  Not true. My client gets out, still goes to church services, and even goes shopping on occasion. The biggest thing hindering him is his mobility which is to be expected with someone of his age.

In essence, these are some of the characteristics of hydrocephalus–both managed (NPH) and unmanaged–and the common fears surrounding the condition. If you have any questions or comments, feel free to leave them below.

Information taken from WebMD/hyrocephalus and the Hydrocephalus Support Group, Inc.
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One Comment

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  1. Rosie / Mar 22 2015 4:17 pm

    Thank you for stimulating interest in NPH. I was diagnosed and shunted a few months ago and am struggling to reclaim my former life as a 58 year old med school professor.

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