Abstract
The mini-monograph presents a comprehensive view on normal pressure hydrocephalus (NPH). NPH is a clinical diagnosis developed due to altered behavior of CSF within the intracranial space.
The clinical manifestation of NPH includes the typical Adams-Hakim triad - gait disorder, cognitive deficit, urinary incontinence - with about half of the patients not having the complete triad. MRI shows ventriculomegaly, often with disproportion in the size of subarachnoid spaces (dilated Sylvian fissures, high convexity tightness) without an obstruction in CSF flow.
From the point of therapy, mild cortical atrophy or the occurrence of chronic ischemic changes is to some extent accepted. The basic attribute of NPH is the presence of normal CSF pressure during lumbar puncture, but with the help of special invasive tests the alteration of CSF behavior within the intracranial space can be measured with a significant estimated accuracy (lumbar infusion test, intracranial pressure monitoring).
Selection of surgical candidates is in most cases performed on the basis of predictive CSF diversion tests (tap test, extended lumbar drainage). The pathophysiology of the most common idiopathic form of NPH is only partially explained despite more than 50 years from the first findings.
Idiopathic form of NPH typically arises at an advanced age, and thus it is an important differential diagnosis of neurodegenerative diseases. The importance of the diagnosis increases with the fact that the natural course of the disease could be to a large extent modified by surgical treatment in the form of implantation of a CSF shunt system a ventriculo-peritoneal shunt (in most cases).