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Hydrocephalus, Normal Pressure

Dennis E. Hughes, DO, FAAFP, FACEP Reviewed 06/2019
 


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
Nassar BR, Lippa CF. Idiopathic normal pressure hydrocephalus: a review for general practitioners. Gerontol Geriatr Med.  2016;2:2333721416643702. [View Abstract on OvidMedline]
2
Willi...

ADDITIONAL READING

  • Andrén K, Wikkelsø C, Tisell M, et al. Natural course of idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry.  2014;85(7):806–810. [View Abstract on OvidMed...

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

ICD9

  • 331.5...

CLINICAL PEARLS

  • NPH is a clinical triad of gait instability, incontinence, and dementia (mnemonic: wet, wobbly, wacky).

  • NPH is insidious and usually progressive; gait instability usually manifests init...

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