Normal-pressure hydrocephalus (NPH) is a neurological condition in which excess cerebrospinal fluid (CSF) occurs in the ventricles, and with normal or slightly elevated cerebrospinal fluid pressure. As the fluid builds up, it causes the ventricles to enlarge and the pressure inside the head to increase, compressing surrounding brain tissue and leading to neurologic and psychiatric symptoms. The etiology of NPH remains poorly understand and diagnosis and management remains controversial to this day.[1]
| International Guidelines (2005) | Japanese Guidelines (2012) | |
|---|---|---|
| Clinical features (Probable) | Gait/balance disturbance and at least 1 of the following:a. Cognitive impairment b. Urinary incontinence/urgency | At least 2 of the clinical triad:a. Gait disturbance b. Cognitive impairment c. Urinary incontinence |
| Clinical features (Possible) | Symptoms of either: a. Incontinence and/or cognitive impairment in the absence of gait/balance disturbance b. Gait disturbance alone | Same as probable |
| Brain imaging (Probable) | Ventriculomegaly (EI > 0.3) and at least 1 of the following:a. Narrow callosal angle b. Enlargement of the temporal horns c. Periventricular signal changes not attributable to ischemic changes or demyelination | Ventriculomegaly (EI > 0.3) and narrowing of the sulci over the high convexity, or presence of disproportionately enlarged subarachnoid space hydrocephalus (DESH) |
| Brain imaging (Possible) | Ventriculomegaly (EI > 0.3) | Ventriculomegaly (EI > 0.3) |
| Duration of symptoms | >3 months | N/A |
| Age | >40 years | >60 years |
| Comorbidities | No other condition | Other neurological condition possible (but “mild”) |
| Opening pressure | 70–245 mm H2O | ≦200 mm H2O |