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normal pressure hydrocephalus disease

Alternative Names
hydrocephalus ex vacuo

Normal pressure hydrocephalus is a condition in which the cerebral ventricles are enlarged. The cerebral ventricles are cavities within the brain that contain the cerebrospinal fluid.

What is going on in the body?
This condition occurs mainly in older people when the ventricles slowly enlarge. Since the skull is not flexible, the brain thins to allow the ventricle to grow. This allows the pressure within the brain to remain normal.

What are the signs and symptoms of the condition?
This disease is typically seen in older people with the following symptoms:
  • impaired thought processes starting with memory loss
  • urinary incontinence, or inability to control urination
  • bowel incontinence, or inability to control bowel movements
  • loss of full control of body movements
What are the causes and risks of the condition?
The cause of this condition is unknown. Symptoms will worsen with lack of treatment. When thought processes and control of body movement become impaired, the person is at increased risk of injury from falling. Poor control of bowel and urinary function may result in urinary tract infections and skin breakdown.

What can be done to prevent the condition?
There is no way to prevent normal pressure hydrocephalus.

How is the condition diagnosed?
Diagnosis is based on imaging studies such as a cranial MRI, cranial CT scan, or cerebral angiogram.

What are the long-term effects of the condition?
Lack of treatment may lead the person to become bedridden, psychotic, and completely unable to control bowel and/or urinary function.

What are the risks to others?
There are no risks to others.

What are the treatments for the condition?
Treatment involves the surgical insertion of a ventriculoperitoneal shunt. The shunt drains cerebrospinal fluid from the enlarged ventricles into the abdomen. Doing this helps relieve the pressure on the ventricle walls, preventing further enlargement. The ventricle may also return to a relatively normal size.

What are the side effects of the treatments?
Infection may occur after surgery. Occasionally, the ventriculoperitoneal shunt may not work properly.

What happens after treatment for the condition?
Rehabilitation therapy can be provided to improve body movements, teach bowel and bladder control, and assist with other problems that interfere with everyday activities. Rehabilitation might include physiotherapy, occupational therapy and speech therapy.

How is the condition monitored?
Monitoring involves watching for return of symptoms. This would indicate that the shunt is not working properly and might need to be repaired. Any new or worsening symptoms should be reported to the doctor.

Author: James Warson, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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