What is Normal Pressure Hydrocephalus?

Normal pressure hydrocephalus (NPH) is the buildup of cerebrospinal fluid in the ventricles of your brain. The surplus fluid enlarges the ventricles, which adds pressure on the brain. Cerebrospinal fluid usually passes through the ventricles to the brain and spinal cord. However, the enlarged ventricles and increased pressure of excess fluid can cause brain damage.

Signs and Symptoms

The signs and symptoms of normal pressure hydrocephalus vary by age. Some normal pressure hydrocephalus symptoms require emergency medical care.

Symptoms in infants:

• Irritability
• Vomiting
• Slow growth
• Tiredness
• Seizures
• Trouble feeding
• Eyes fixed downward
• Weakness
• Reduced muscle growth
• Minimal response to touch

In toddlers, certain features of head size and shape also indicate NPH. For example, if your toddler’s head size grows fast, is abnormally large, or bulges at the top. There may also be a soft spot called a fontanel on the top of their head.

Symptoms in toddlers and children:

• Nausea
• Blurry vision
• Fatigue
• Irritability
• Seizures
• Headache
• Personality change
• Lack of appetite
• Double vision
• Eyes fixed downward
• Vomiting
• Trouble balancing
• Trouble urinating
• Reduced school performance
• Regression in learned skills
• Larger than usual head

Symptoms in young and middle-aged adults:

• Vision issues
• Fatigue
• Headaches
• Loss of bladder control
• Trouble urinating
• Reduced coordination
• Reduced memory
• Reduced focus

Symptoms in older adults:

• Loss of memory
• Loss of bladder control
• Difficulty urinating
• Trouble walking
• Trouble with balance
• Continual loss of thinking skills

The following normal pressure hydrocephalus symptoms in infants and toddlers require immediate medical attention:

• Continuous vomiting
• Trouble breathing
• Seizures
• High-pitched cry
• Trouble with feeding
• Refusal to move their head
• Refusal to lay down

Causes

The exact cause of normal pressure hydrocephalus is unknown. However, excess cerebrospinal fluid can be caused by poor absorption, blockage, and overproduction. When a surplus of fluid backs up in the ventricles for any reason, normal pressure hydrocephalus can occur.

Potential NPH causes:

• Blockage — The most common cause is a blockage. Something might block fluid from flowing through the ventricles or flowing from the ventricles to other parts of the brain.
• Absorption — Poor absorption of the fluid into your bloodstream can result in excess fluid in your ventricles.
• Overproduction — A rare cause might be excess production of cerebrospinal fluid.

Risk Factors

Although NPH is a rare disorder, several risk factors increase your risk for developing the condition. For newborns, abnormal central nervous system development and being delivered by a mother with a uterus infection are risk factors.

Normal pressure hydrocephalus risk factors:

• Bleeding in the ventricles
• Brain tumors
• Spinal cord tumors
• Brain lesions
• Spinal cord lesions
• Brain injury
• Central nervous system infections

Diagnosis

Your doctor will make a normal pressure hydrocephalus diagnosis based on the results of a routine medical review, neurological exam, and imaging test.

Diagnostic process:

• Medical review — Your doctor will ask about your general health, medical history, and symptoms.
• Neurological exam — Your doctor will examine your brain function with tests customized to your age. Typically, this exam involves questions and simple activities.
• Imaging test — Your doctor might use magnetic resonance imaging (MRI), ultrasound, or computerized tomography (CT) scans to identify enlarged ventricles in your brain.

Treatment

The two main surgical treatments for normal pressure hydrocephalus are inserting a shunt and endoscopic third ventriculostomy. Additional nonsurgical normal pressure hydrocephalus treatment options are also available. These options typically involve a team of specialist care providers such as a social worker or physical therapist.

Treatment options:

• Shunt — A shunt is essentially a flexible tube that helps the flow and drainage of cerebrospinal fluid.
• Endoscopic third ventriculostomy — A surgeon makes a tiny incision in one of the ventricles or between the ventricles.
• Care Team — You may benefit from additional treatment for long term complications of normal pressure hydrocephalus. Depending on your age, this additional treatment might be provided by a mental health worker, social worker, pediatrician, occupational therapist, special education teacher, or developmental therapist.

Complications

Complications from normal pressure hydrocephalus depend on the severity of the condition, the underlying cause, and your general health.

Complications might include:

• Intellectual disabilities — Mental delays and reduced performance IQ can sometimes occur. Other intellectual issues might also arise.
• Physical disabilities — Possible issues include infertility, epilepsy, diabetes, and other disabilities.
• Developmental disabilities — Among other potential issues, slow growth or obesity might occur.

If you or a loved one experience any of the signs of normal pressure hydrocephalus, a neurologist at Baptist Health may be able to help.