Risk Factors and Causes for Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) can develop after a stroke, head injury, brain surgery, meningitis, or any disorder that causes bleeding around the brain. The presence of a brain tumor may also cause normal pressure hydrocephalus. In most cases, however, the cause for NPH is unknown.

Normal Pressure Hydrocephalus Signs and Symptoms

In general, a combination of the following symptoms may indicate normal pressure hydrocephalus (NPH):

  • Frequent urination or the urgent need to urinate
  • Gait disturbance (difficulty walking)
  • Mild dementia (a progressive impairment of mental abilities)

Additional symptoms of NPH, such as headache, nausea, and vision problems, can also occur due to the increased pressure on the brain.

The first noticeable symptom of NPH is often a gait disturbance, or having trouble walking or balancing. Commonly, people with NPH may walk with slow, short, shuffling steps and keep a wide stance (for balance) when standing still, or even when walking. People with NPH may also feel as if they cannot lift their foot from the floor. They may feel weak and unsteady in their legs, have a hard time getting started walking, and experience sudden falls.

Signs of dementia often associated with normal pressure hydrocephalus may include having trouble remembering (memory loss), being unusually slow to speak or to understand what is being spoken, having difficulties with tasks that were once routine, and a reduced attention span. The person may also have difficulties with basic reasoning and problem-solving. A general lack of interest in life, as well as changes in behavior and mood, may also accompany NPH.

People in the early stages of NPH may also feel a frequent or urgent need to urinate. Later, as the effects of NPH worsen, these urinary symptoms may progress to incontinence, or the inability to control the flow of urine. In fact, incontinence is often associated with more advanced cases of NPH.

Early signs of normal pressure hydrocephalus may go unnoticed because they can seem subtle, or insignificant. For example, some people with NPH think signs of urinary difficulties are not worth noting and thus neglect to report them to their health care provider. People often associate the symptoms of NPH with the typical signs of aging, so the early warning signs for NPH may simply be ignored or overlooked. However, the good news is that those who are diagnosed early on generally have a higher success rate for treatment and for a much-improved quality of life. If you notice any of the above signs in yourself or a family member, contact your health care provider.

Publication Review By: Alan B. Ettinger, M.D.

Published: 06 May 2006

Last Modified: 28 Sep 2015