Normal pressure hydrocephalus (NPH) is a condition where fluid builds up inside or around the brain, disrupting brain function. Cerebrospinal fluid (CSF) is a liquid that cushions your brain and spinal cord. It delivers nutrients, gets rid of waste products, and protects your brain and spinal cord from trauma and injury. CSF also fills the four cavities within the brain, called ventricles. When there's too much fluid, the ventricles get larger, pressing on your brain and damaging nearby tissue. This can lead to problems with bladder control, memory, movement, thinking, and walking.

Sometimes referred to as NPH disease, normal pressure hydrocephalus mainly affects people older than 65. You're also at an increased risk if you have a brain infection or brain tumor, experience a head injury, or have had brain surgery. NPH can be stopped or reversed if treated soon after symptoms appear.

Normal pressure hydrocephalus is treated by a doctor who specializes in neurological disorders called a neurologist. Neurologists at Penn Medicine are among the leading neurology providers in southeastern Pennsylvania and the South Jersey region who are experts in diagnosing and treating brain conditions like normal pressure hydrocephalus and providing follow-up care and support.

Normal pressure hydrocephalus symptoms develop slowly, usually over three to six months. The classic signs of NPH are often referred to as the "triad" and include: 

• Cognitive issues: Memory loss, problems with attention and concentration, and a decline in executive functioning such as planning, organizing, and problem-solving.
• Gait disturbances: Problems with walking, including instability, shuffling feet, and a tendency to fall.
• Urinary incontinence: Difficulty controlling urination, often characterized by frequent or urgent urination, and sometimes accompanied by bladder dysfunction.

The exact cause of normal pressure hydrocephalus is unknown, but it can result from a variety of factors, including:

• Bleeding in the brain: Bleeding, such as from a stroke or head trauma, can interfere with cerebrospinal fluid (CSF) circulation and absorption.
• Brain surgery: Previous brain surgery or procedures involving the brain can sometimes disrupt the normal flow and absorption of CSF.
• Infections: Infections affecting the brain or its surrounding structures can cause inflammation and blockages in the CSF pathways.
• Injury: Head trauma can lead to the development of NPH.
• Tumors: Brain tumors or other growths can obstruct the flow of CSF.

While these factors may contribute to the development of NPH, not everyone with these risk factors will develop it.

Since the cause of normal pressure hydrocephalus is unknown, it can’t be prevented. However, there are habits you can develop to reduce your risk factors.

• Manage underlying conditions: Certain health problems can make you more likely to develop issues like aneurysms or bleeding in the brain, which can increase your chances of getting NPH. You can lower this risk by managing things like your blood pressure and taking care of related conditions such as type 2 diabetes.
• Get medical care: Seek prompt medical attention for any symptoms that may indicate signs of NPH.
• Pay attention to infections: If you have an ear or eye infection, get medical care as soon as possible. Some infections can spread to the brain and potentially cause inflammation and swelling.
• Protect your head: Take precautions to prevent traumatic injuries to the head, such as wearing appropriate safety gear during sports or activities with a risk of head injury.

While it’s not possible to prevent all cases of NPH, taking proactive steps to promote overall health and minimize specific risks can help reduce your likelihood of developing it.