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Normal Pressure Hydrocephalus (NPH)

Normal pressure hydrocephalus happens when brain fluid builds up abnormally. This condition, which is common in older adults, is treatable. Yet many people do not receive the care they need because symptoms can be mistaken for other neurologic problems, including Alzheimer’s disease.

The Washington University and Barnes-Jewish Neurology & Neurosurgery Center has a team of doctors who specialize in diagnosing and treating normal pressure hydrocephalus. Our team is one of few in the St. Louis region delivering effective, personalized care for patients suffering from NPH. With proper treatment, you or your loved one may return to everyday activities, such as driving and walking without assistance.

About Normal Pressure Hydrocephalus (NPH)

With NPH, fluid pools in pockets of brain tissue called ventricles. The fluid buildups cause the ventricles to push out against nearby brain tissue. Surgically placing a small device (shunt) in the brain drains away the extra fluid and relieves symptoms.

NPH usually causes three symptoms. Some patients experience only one, while others have all three:

  1. Dementia: Difficulty with thinking and memory
  2. Bladder control problems: An urgent need to empty your bladder or frequent accidents
  3. Gait problems: Abnormal patterns of moving your feet when walking

NPH Care: Why Choose Us?

Our team includes Washington University Physicians specializing in every aspect of NPH care. These specialists have been working together for years. As a result, our close collaboration enables us to streamline your care journey. Patients often undergo a comprehensive evaluation and shunt surgery in the same week.

Highlights of our program include:

  • Expertise: All of our NPH specialists have completed specialized training through residencies in areas such as neurology and neurosurgery. This level of expertise means you can count on us for exceptional care. Find a doctor.
  • Complete care: We perform a detailed evaluation to assess symptoms and determine whether a shunt is likely to relieve them. Our approach helps you or your loved one receive safe, effective treatment as quickly as possible.
  • Research: We are advancing NPH care through research. These efforts may help us better predict which patients will benefit from shunt surgery. Find out more about the Washington University Office of Neuroscience Research.
  • Coordination: If you or your loved one has symptoms due to another condition, such as Parkinson’s disease, we connect them to specialists in our nationally recognized Neuroscience Center. Read more about neurology and neurosurgery.

NPH Care Team

Our experts work together to deliver personalized care, including any tests, treatments and therapies your loved one may need.

Our NPH care team includes:

  • Neurologists
  • Neurosurgeons
  • Neuroradiologists (radiologists who specialize in brain imaging)
  • Physical therapists
  • Neuropsychologists (doctors who evaluate memory and thinking problems)

Diagnosing NPH

NPH can be difficult to diagnose because it often does not increase pressure within the skull, which is a common symptom in other forms of hydrocephalus. Our team coordinates multiple assessments to accurately diagnose NPH:

  • Neurologists evaluate brain functioning
  • Neuroradiologists interpret brain imaging studies
  • Neuropsychologists explore how symptoms are affecting thinking and memory
  • Physical therapists determine the type of gait problem your loved one is experiencing and how serious it is

Confirming an NPH Diagnosis

Neuroradiologists perform magnetic resonance imaging (MRI) tests to learn more about the flow of fluid through the brain. We also look for problems such as microbleeds from abnormal blood vessels that could get in the way of successful shunt surgery.

We conduct inpatient testing using a small tube to withdraw samples of brain fluid over a period of two to three days (lumbar drain trial). If symptoms improve during the testing period, a permanent shunt is likely to effectively treat your NPH.

Treating NPH

We implant the shunt during a short surgical procedure. Patients receive care from nationally recognized neurosurgeons who specialize in treating NPH.

Our neurosurgeons implants the shunt through a small incision in the head. The shunt extends from the brain, down the neck and chest, to the top part of the abdomen. With the shunt in place, excess fluid travels from the brain to the abdomen, where the body absorbs it.

We use programmable shunts. These devices allow our team to adjust settings to meet your needs during an office visit, instead of requiring additional procedures.

Shunts are also MRI-compatible. MRI scanners use strong magnets to create images and can be sensitive to certain materials, such as metal implants. Shunts are made out of a material that does not interfere with the MRI magnet, so you can safely undergo additional imaging tests, if necessary, and the images will not be distorted.

Recovering From NPH Shunt Surgery

Many people feel better within a few days. Most people return to daily activities, such as driving, within a few months.

We help your loved one make a safe transition back to daily activities with inpatient and outpatient rehabilitative therapy. Therapy helps your loved one re-learn how to walk without assistance.

Contact Us

To make an appointment with a Washington University NPH specialist at Barnes-Jewish Hospital, call 855.925.0631.


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