Frequently Asked Questions About Normal Pressure Hydrocephalus

In many cases, the underlying cause cannot be identified. NPH may occur as a result of head trauma, previous brain hemorrhage, tumors or cysts, bleeding seen during surgery, meningitis, or other brain infections.

It helps measure the approximate CSF pressure and also helps analyze the fluid. Under local anesthesia, up to 50 cc of CSF is drained by inserting a thin needle into the lower back. In this way, a temporary improvement in the patient’s symptoms is expected. If there is a significant improvement in the symptoms, even temporarily, after this procedure, then it can be said that surgical treatment is likely to be successful. If the response to lumbar puncture is negative or cannot be clearly understood, then more advanced investigations are required.

Although many tests and studies have been developed for this purpose, there is no single factor that can predict the success of the shunt procedure on its own. The following findings suggest that outcomes will be better after shunt placement: Walking impairment being the first and most prominent complaint The presence of a known cause of NPH such as trauma or bleeding Ventricular size being disproportionately enlarged compared with the subarachnoid space where CSF is located on imaging methods Dramatic temporary improvement after CSF drainage through lumbar puncture or lumbar catheter Measured intracranial or spinal CSF pressure being at upper limits Minimal evidence of small vessel disease affecting the brain It is important to know that hydrocephalus symptoms may improve after shunting. Although complete recovery after surgery is everyone’s expectation, this may not always be possible. A significant reduction in existing complaints after surgery, freeing the person from dependence on others, and most importantly preventing further progression of neurological symptoms is a satisfactory result for the patient and relatives.

Walking impairment, mild dementia, and bladder control problems may improve within a few days after surgery, or it may take weeks to months for improvement. Unfortunately, there is no way to predict in advance how quickly and to what degree this improvement will occur. In those who do improve, these improvements often occur within the first weeks. This recovery may be mild, or it may be very dramatic.

Patients with NPH often present with progressive symptoms, and there is no reason to believe that these symptoms will improve on their own or that the clinical deterioration will stop by itself. No one can predict how quickly the current symptoms will progress. The more severe the symptoms are and the longer they have been present, the less response there will be to treatment. As a general rule, the earlier the diagnosis and treatment are made, the better the improvement will be. If the symptoms are very mild, the patient may be closely followed for a while without performing an urgent shunt operation.