Normal pressure hydrocephalus: Difference between revisions
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*[[LP]]: normal opening pressure | *[[LP]]: normal opening pressure | ||
**Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref> | **Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref> | ||
*[[CT brain]] | *[[CT brain]]: Ventriculomegaly without signs of obstruction at the level of the third or fourth ventricles | ||
==Management== | ==Management== | ||
Revision as of 21:54, 26 March 2020
Background
- Possible reversible cause of dementia
- CSF buildup in the ventricles leading to increased intracranial pressure with edema of the periventricular white matter and corona radiata
- Sacral motor nerve fibers that produce gait instability; incontinence ensues when compressed
Clinical Features
- Gait disturbance is most common and earliest finding
- "Glue-footed" gait: move slowly, take small steps, often wide base, with difficulty turning
- Memory loss and dementia symptoms may be mild, subtle
- Incontinence is usually later stage, though sensation of urinary urgency is usually present before incontinence
- Usually do not have symptoms of increased intracranial pressure, such as headache, nausea, vomiting, visual loss
Differential Diagnosis
- Alzheimer's
- Stroke
- Parkinson's disease
- Electrolyte abnormality
- Malignancy
- Uremic encephalopathy
- Hydrocephalus ex vacuo (diffuse cerebral atrophy on CT)
Evaluation
- CBC
- Chem 7
- LP: normal opening pressure
- Symptom improvement supports diagnosis[1]
- CT brain: Ventriculomegaly without signs of obstruction at the level of the third or fourth ventricles
Management
- Diagnostic and therapeutic large volume CSF removal
- Additional work up warranted for surgical candidate[1] [2]
- Assessment for Surgical CSF shunting
Disposition
- Workup typically is extensive and performed as an outpatient.
- Refer to neurosurgery
Also See
References
- ↑ 1.0 1.1 Schneck MJ. Normal pressure hydrocephalus. Medscape. Retrieved 8/4/2016
- ↑ Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008 Sep;8(5):371-6.