Approach to Normal Pressure Hydrocephalus (NPH)

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 neuropsychiatric complications.

The triad consists of gait deviation, dementia, and urinary incontinence (commonly referred to as “wet, wacky, and wobbly” or “weird walking water”). Gait deviations are present in nearly all patients and usually the first symptom.

A classic “magnetic gait” can be seen in NPH, this gait is often described as if one's feet were “stuck to the ground.”[1]