Normal Pressure Hydrocephalus (NPH)
Radiographic Findings
See Communicating Hydrocephalus
Ventriculomegaly with minimal or no cortical atrophy
- There is enlargement of the ventricles (we see stretching of the basal ganglia and thalamus) BUT there are normal gyral folds (minimal or no atrophy).
- Whereas the most common cause of ventriculomegaly is cortical atrophy (called hydrocephalus ex vacuo) in which ventriculomegaly is secondary to brain atrophy, in NPH there is hydrocephalus with minimal brain atrophy.
Key Clinical Features: "Wacky, Wobbly, Wet"
- Wacky refers to the dementia, which, as a simplicity, manifests with a prefrontal subcortical dementia in which there is attentional impairment, along with prominent executive dysfunction, as well as memory loss and anomia.
- Wobbly refers to the gait apraxia; we show a patient with a symmetrically wide base standing above a magnetic, which keeps the feet “glued” to the floor, which results, at least in part, from stretching on the medial frontal cortex. It affects gait initiation, turning, and transitions, and results in tripping and falls.
- Wet refers to urinary urgency and incontinence, secondary to pathologic stretching (with resultant distortion and ischemia) of widespread supraspinal micturition pathways within the brainstem (especially the pontine micturition center), medial frontal lobe (anterior cingulate gyrus and prefrontal cortex), hypothalamus, and other regions.
Treatment via ventriculoperitoneal shunt
- Treatment involves a CSF shunt.
- It is placed in one of the lateral ventricles and drains into the abdominal peritoneum.