Normal Pressure Hydrocephalus Program

The Froedtert & the Medical College of Wisconsin Normal Pressure Hydrocephalus Program is the only program in the state of Wisconsin, and one of the few in the country, dedicated to evaluating and managing normal pressure hydrocephalus (NPH).

The NPH program offers comprehensive diagnostic and state of art treatment options for patients with NPH. Our program uses a multidisciplinary team approach and an exceptional staff with experts in neurology, neurosurgery and neuropsychology. These specialists have monthly interdisciplinary conferences, where they review and discuss every case.

Using their combined expertise, advanced imaging and modern monitoring methods, our team of specialists offers the best answer for NPH treatment.

Understanding Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is an increase in the amount of cerebrospinal fluid (CSF) in the brain without a corresponding increase in pressure. CSF is a clear fluid that circulates within the four ventricles, or cavities, of the brain. It surrounds the brain and spinal cord (the central nervous system). The function of CSF is to cushion and protect the central nervous system. CSF also provides nutrients to and removes certain wastes from the central nervous system.

CSF is constantly formed and absorbed to maintain a constant amount and pressure within the brain. CSF is absorbed in the space near the top of the brain and drains into the veins, allowing it to leave the brain by entering the bloodstream. In NPH, CSF production seems to be normal, but there appears to be a problem with the absorption of CSF in the brain. Because CSF is not absorbed properly, CSF builds up. This increases the size of the ventricles and causes tension on surrounding brain tissue. 

The exact cause of NPH is not well understood. About half of NPH cases have no known cause (called idiopathic NPH). The other half of cases are associated with an identifiable cause such as meningitis, a head injury or a subarachnoid hemorrhage (a type of stroke that occurs when a blood vessel outside the brain ruptures). NPH is a progressive condition, and the symptoms gradually worsen. 

NPH at a Glance

• Normal pressure hydrocephalus (NPH) usually affects people age 60 and over.
• An estimated 200,000 to 375,000 Americans suffer from NPH.
• NPH can be difficult to diagnose because its symptoms may be confused with other disorders such as Alzheimer’s disease and Parkinson’s disease.
• NPH is believed to cause up to 5 percent of all cases of dementia.
• If diagnosed early, NPH symptoms can be reduced.

NPH Symptoms

NPH is usually characterized by three symptoms — gait (walking) disturbance, poor bladder control and dementia. In addition, the cavities of the brain are dilated, and cerebrospinal fluid (CSF) pressure is normal. These symptoms may not occur all at the same time, and sometimes only one or two symptoms are present.

• Gait disturbance, often the most pronounced symptom, ranges in severity. A person with NPH has a gait that is often slow, wide-based and short-stepped with shuffling. A person may have trouble picking up his or her feet and may have difficulty starting to walk and turning around. Imbalance and falling can become a problem. The gait may mimic the way a person with Parkinson’s disease walks.
• Dementia can be described as poor memory, difficulty with attention, slowness in processing information, loss of interest in daily activities, apathy and dullness in thinking and actions. NPH causes up to 5 percent of dementia cases.
• Impaired bladder control is usually characterized by increased urinary frequency and urgency in mild cases, or bladder incontinence in more severe cases.

The symptoms of hydrocephalus seem to progress with time. Symptoms can be present for months or even years before a person sees a physician.

Because the symptoms of NPH are similar to those of Alzheimer’s disease, Parkinson’s disease and other disorders, NPH may be misdiagnosed. Many cases are never diagnosed and, therefore, are never properly treated. It’s important to make an accurate diagnosis, because treatment for NPH is very different from treatment for other causes of these symptoms. The team of the NPH Program at Froedtert & the Medical College of Wisconsin has the expertise to accurately diagnose NPH.