A Neurologist’s Evaluation is Key to Diagnosing Normal Pressure Hydrocephalus (NPH)

Normal Pressure Hydrocephalus (NPH) is a rare and serious condition that occurs most often in people over age 60. NPH is an abnormal buildup of cerebrospinal fluid in the ventricles of the brain. This causes the ventricles to enlarge, creating compression that leads to neurological problems. 

NPH is difficult to diagnose because its symptoms are frequently seen in other diseases, such as Alzheimer’s disease and Parkinson’s disease. MUSC Health now offers an NPH-specific clinic to bring the expertise of neurologists to the process of definitive diagnosis. 

Diagnosing Normal Pressure Hydrocephalus

“We are trying to streamline the process and increase access for patients with possible NPH,” says neurologist Lidia Yamada, M. D., assistant professor of Neurology at MUSC. In the clinic, Dr. Yamada collaborates with neurosurgeons, physical therapists and neuropsychologists to carry out extensive evaluation and testing.

Because NPH is rare, general practitioners don’t initially think of it. “So, two things can happen,” Dr. Yamada says. “Either the NPH is not correctly diagnosed and the opportunity for treatment is lost or NPH is incorrectly diagnosed, and patients go through brain surgery without indication.”

How MUSC Evaluates for NPH

MUSC Health’s team offers an extensive neurological evaluation that utilizes the clinical expertise and technology of the academic medical center. The evaluation looks for enlargement of the brain in association with gait changes and memory and bladder control problems.

NPH Treatment

If highly suspected, NPH is commonly treated with a shunt that will help drain the excess fluid. To evaluate whether the patient has a higher chance of improvement with the shunt, a pre-surgery test with a lumbar drain (or a large-volume spinal tap) is done. In many cases, a shunt helps relieve the symptoms, but in others, it does not.

“It’s important for people to know that these treatments are not perfect,” says Dr. Yamada. “NPH is a mystery in many ways. We don’t know why some patients improve and others don’t. But having the correct diagnosis is the first step toward increasing the chances of improvement, as well as avoiding unnecessary procedures.”

If you or an elderly relative have changes in gait or thinking or loss of bladder control, contact a health provider. Prompt diagnosis and treatment of NPH improve the chances of an optimal outcome.