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Normal Pressure Hydrocephalus (NPH)

Paddy Kalish OD Blog Normal Pressure Hydrocephalus (NPH)

Normal Pressure Hydrocephalus (NPH) is a neurological condition characterized by an accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, leading to ventricular enlargement.

Here is an overview: Symptoms: 1. Gait disturbance (magnetic gait, difficulty walking) 2. Dementia (memory loss, cognitive decline) 3. Urinary incontinence Causes: 1. Blockage of CSF flow or absorption 2. Head trauma 3. Infections (meningitis, encephalitis) 4. Brain tumors or cysts 5. Aging

Ocular signs of hydrocephalus include: 
 
  • Vision changes: Blurred vision, reduced vision, double vision, or grayouts or fuzzouts of vision 
     
  • Eye misalignment: Strabismus, or eyes looking outwards and downwards 
     
  • Other eye problems: Unstable or shaking eyes, abnormal pupil reaction to light, or less than 20/20 vision 
     
  • Setting-sun sign:  eyes that look downwards 
     
  • Saccadic eye movement: Impaired rapid jumps of eye movement from one position to another 

Diagnosis: 1. Imaging studies (CT, MRI, or PET scans) 2. Lumbar puncture (spinal tap) 3. CSF analysis 4. Gait and cognitive assessments

https://youtu.be/F1xO41erT90?si=-kDHoAPJMbwFn6UU

Treatment: 1. Ventriculoperitoneal shunting (surgical implantation of a shunt to drain excess CSF) 2. Lumbar punctures (temporary CSF drainage) 3. Medications (diuretics, acetazolamide) 4. Rehabilitation (physical, occupational, and cognitive therapy)

Prognosis: 1. Variable, depending on underlying cause and treatment effectiveness 2. Shunting can improve symptoms, but may not reverse damage 3. Close monitoring and management are crucial NPH can be misdiagnosed as Alzheimer's disease or Parkinson's disease due to similar symptoms. Accurate diagnosis and timely treatment are essential for optimal outcomes. 

Author
Paddy Kalish OD, JD and B.Arch

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