Normal pressure hydrocephalus
The gait-first triad, ventriculomegaly with DESH, who to send for a tap test or lumbar drain, what the PENS shunt trial showed, and the shunt complications physicians meet.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Communicating hydrocephalus of older adults (usually over 60) with a normal or mildly raised CSF opening pressure.
- Gait disturbance first, then cognitive slowing, then urinary urgency and incontinence. The full triad is a late finding.
- Diagnosis rests on the clinical picture, ventriculomegaly out of proportion to atrophy, and response to CSF removal.
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Sources
- Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus (Nakajima M et al. Neurol Med Chir 2021;61:63-97)Japanese Society of Normal Pressure Hydrocephalus, 2021
- Diagnosing idiopathic normal-pressure hydrocephalus (Relkin N et al. Neurosurgery 2005;57:S4-16)International iNPH guidelines (Neurosurgery), 2005
- Hamilton MG, Williams MA, Edwards S et al. Guidelines for diagnosis and management of idiopathic normal pressure hydrocephalus. Neurosurg Clin N Am 2025;36:199-205Neurosurgery Clinics of North America, 2025
- Luciano MG, Williams MA, Hamilton MG et al. A randomized trial of shunting for idiopathic normal-pressure hydrocephalus (PENS). N Engl J Med 2025;393:2198-2209New England Journal of Medicine, 2025
- Virhammar J, Fasth O, Ekblom M et al. Safety, tolerability, and efficacy of acetazolamide in idiopathic normal pressure hydrocephalus (DRAIN) in Sweden: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol 2026;25:550-559The Lancet Neurology, 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy