Exam Cram

• NPH: Normal Pressure Hydrocephalus results from excessive CSF with cerebral compensation by ventricle enlargement

• Presentation: memory loss, urinary incontinence and ataxia

• CT-Head: enlarged ventricles, LP- normal pressure

• Management: acetazolamide, large volume lumbar puncture, therapeutic CSF shunt

Outline

Background 

• CSF build up, brain compensated by increasing size of ventricles to ensure normal lumbar puncture opening pressure

• Type of dementia

Assessment

History:

• Dementia

• Urinary incontinence

• Immobility

Examination:

• Broad based gait

Investigations

• CT-Head: enlarged ventricles

• Lumbar puncture opening pressure 12-25

• MMSE < 25/30

Diagnosis

Diagnostic criteria: 

1. Clinical triad: Urinary incontinence, ataxia, memory loss (dementia)

2. MRI / CT-H- enlarged ventricles

3. LP- normal pressure & improvement with drainage

Differentials: Alzheimer's Disease

Management

1. Therapeutic LP task- large volume

2. CSF Shunt

Med Reg Notes

• Acetolazide (carbonic anhydrase inhibitors) a medical option

References

1. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/normal-pressure-hydrocephalus#:~:text=Normal%20pressure%20hydrocephalus%20(NPH)%20is,and%20loss%20of%20bladder%20control.

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