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Hydrocephalus, Normal Pressure

Dennis E Hughes, DO FACEP Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Normal pressure hydrocephalus (NPH) is a clinical triad of gait instability, incontinence, and dementia (mnemonic: wet, wobbly, wacky); originally described by Hakim in 1957

  • Two forms...

DIAGNOSIS

Detailed history and careful examination is the key to early diagnosis. 

HISTORY

  • Insidious and usually progressive; gait instability usually manifests initially, followed by changes in mentati...

TREATMENT

MEDICATION

  • No medication is significantly helpful.

  • Use of carbonic anhydrase inhibitors (acetazolamide) with repeat lumbar punctures has provided mild and transient relief but is only supporte...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Assessment and modification of environment for fall risks

  • Evaluation for ability to operate a motor vehicle safely (if driving)

Patient Monitoring

  • Repeat neuropsycho...

REFERENCES

1
Oike R, Inoue Y, Matsuzawa K, Sorimachi T. Screening for idiopathic normal pressure hydrocephalus in the elderly after falls. Clin Neurol Neurosurg. 2021 Apr 24;205:106635.
2
Wang Z, Zhang Y...

SEE ALSO

Algorithm: Ataxia 

CODES

ICD10

  • G91.2 (Idiopathic) normal pressure hydrocephalus

  • G91.0 Communicating hydrocephalus

  • G91.3 Post-traumatic hydrocephalus, unspecified

  • G91.4 Hydrocephalus in diseases classified elsewhere

SNOMED

  • 307...

CLINICAL PEARLS

  • Consider in unexplained dementia or behavioral change.

  • Insidious and usually progressive; gait instability usually manifests initially, followed by changes in mentation, and eventually,...

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