Normal pressure hydrocephalus

Abstract

Idiopathic normal pressure hydrocephalus (INPH) is characterized by progressivegait apraxia, cognitive dysfunction and urinary incontinence (Hakim-Adams syndrome).INPH is associated with communicating hydrocephalus (as demonstrated by brain CT orMRI) and cerebrospinal fluid (CSF) pressure within the normal range (7-24 cm H2O).The clinical triad of Hakim-Adams syndrome is present in approximately 50% of cases;however, only one or a combination of two symptoms should be considered fordiagnostic investigation. It is a differential diagnosis for most of the dementia syndromesand occurs mainly in elderly populations and it is one of the causes of potentiallyreversible dementia. Treatment of INPH is based in three pillars: conservative,ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV).Conclusion: Appropriate and well designed high-level evidence studies are still lacking,but the current gold standard treatment of INPH is performed with VPS.