Normal Pressure Hydrocephalus (NPH)

NPH is a type of hydrocephalus. It happens when too much cerebrospinal fluid (CSF) — the clear fluid around your brain and spinal cord — accumulates inside cavities of your brain called ventricles. This fluid buildup affects how your brain functions, causing it to stop working the way it should. NPH is believed to be linked to changes in your brain’s blood vessels that occur with age and can affect how CSF drains. This is known as idiopathic NPH. In some cases, NPH can develop after other problems, such as bleeding in the brain, an infection or head trauma. This is called secondary NPH.

Diagnosing NPH at Cleveland Clinic London

NPH can be difficult to diagnose because its symptoms — trouble walking, memory problems or bladder issues — are often mistaken for signs of ageing or conditions like dementia or Parkinson’s disease. An important finding that can point to NPH, though, are enlarged cerebral ventricles that show up on brain scans. That’s why it’s important to see an experienced specialist who understands NPH and what to look for.

What to expect at your first appointment

At your first appointment, your consultant will ask about your medical history and whether you have ever had a head injury or accident. They will also want to hear about your symptoms and any tests you’ve had before. All of this information helps them get a full understanding of your situation and is an important first step toward making a diagnosis.

Next, you will have a physical and neurological exam to test your senses, reflexes and muscle strength in your arms and legs. Your consultant may also order other tests, including:

• CT scan or MRI: These imaging tests are key to diagnosing NPH. They give your consultant a detailed view of your brain so they can see areas where cerebrospinal fluid has accumulated.
• Lumbar puncture (spinal tap) or extended lumbar drain (ELD): These procedures are used to drain some CSF to see if symptoms improve. Testing the CSF can also help rule out other possible conditions. Since your body produces a large amount of CSF daily, removing some of it can temporarily relieve symptoms. If symptoms return as the fluid builds up again, it can help confirm a diagnosis of NPH.

The most common treatment for NPH is the insertion of a shunt — a thin tube placed into the fluid-filled spaces in your brain (ventricles) through a small opening in your skull. The tube runs under your skin to another part of your body (usually your abdominal cavity), where the excess CSF can be safely absorbed. This procedure typically takes around two hours and involves a hospital stay of about 48 hours. As with any surgery, there are risks, but serious complications from shunt surgery for NPH are relatively uncommon.

Medications are not used to treat NPH because the condition doesn’t respond well to them. They may be used, though, to treat some symptoms related to NPH.

Rehabilitation therapy

Physiotherapy and occupational therapy are often key components of an effective treatment plan for NPH. Your consultant may recommend one or both of these therapies to help you regain function after surgery.

• Physiotherapy: Can help improve your balance, coordination and gait (walking), strengthen your muscles and increase flexibility
• Occupational therapy: Can help you adapt to changes in mobility, teach you new ways to do everyday tasks, like dressing or showering and provide memory and other cognitive strategies

Follow-up Care for NPH

Follow-up care is essential after treatment for NPH to make sure you stay healthy and manage any complications (although these are rare). If you have shunt surgery, it’s important to get regular checkups to ensure the shunt is working properly. If needed, your consultant may order additional CT scans or MRIs. They’ll also monitor your symptoms to make sure they’re improving.

Paying for NPH Treatment at Cleveland Clinic London

We offer transparent pricing and two convenient options to pay for your NPH treatment. You may choose to self-pay or use private medical insurance. If you have questions regarding the financial side of your care, please contact us and we’ll connect you with a payment specialist.

What’s Next?

It’s easy to brush off certain symptoms — like a slower walk, a few memory lapses and more frequent trips to the toilet — as just part of getting older. But when these changes start to affect your daily life, it’s important to find out if they could point to something more. At Cleveland Clinic London, our team is here to help you make sense of what you’re experiencing and find solutions. If we discover you have normal pressure hydrocephalus, we will provide expert, compassionate care that’s tailored to your needs.