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Hydrocephalus, Normal Pressure

Dennis E Hughes, DO FACEP Reviewed 04/2024
 


BASICS

DESCRIPTION

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

  • Two ...

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
Wang Z, Zhang Y, Hu F, Ding J, Wang X. Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus. CNS Neurosci Ther. 2020;26(12):1230-1240.
2
Carswell C. Idiopathic normal...

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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