Normal Pressure Hydrocephalus
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Introduction
Normal pressure hydrocephalus is a condition in which intracranial pressure is intermittently elevated. Impaired CSF absorption is proposed to be one mechanism, which can occur after damage to the arachniod villi following meningitis.
Progressive dementia, urinary incontinence, and gait disturbance are usually present.
This is in contrast with obstructive hydrocephalus, in which CSF outflow is blocked, typically within the cerebral aqueduct (of Sylvius).
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
clinical triad:
wobbly, wet, and weird
Triad:
- gait impairment (magnetic gait)
- urinary incontinence
- dementia
Gait impairment is usually the earliest; if dementia comes first, this is not likely the diagnosis.
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Spinal tap reveals normal pressure, but
Diagnostic Imaging
MRI or CT demonstrates ventricular enlargement.
Differential Diagnosis
Treatments
Shunting from the ventricles to the peritoneal cavity or venous system can reduce ventricular size and reduce symptoms.
Consequences and Course
The Case of...
Case #2 - a small story wrapping it all up and asking especially about management.
Additional Resources
any good free online resources for further reading.
Topic Development
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