✍ Normal pressure hydrocephalus

‍ 🧩 Medical Mnemonics

✍ Normal pressure hydrocephalus (NPH) refers to a condition of pathologically enlarged ventricular size with normal opening pressures on lumbar puncture. NPH is a form of communicating hydrocephalus and is distinguished from obstructive or noncommunicating hydrocephalus, in which there is a structural blockage of the cerebrospinal fluid (CSF) circulation within the ventricular system (eg, stenosis of aqueduct of Sylvius).

🔺 NPH is associated with a classic triad of dementia, gait disturbance, and urinary incontinence. The patients appear to walk with a broad base and with their feet stuck to the floor (no lifting up the knees). There is a #mnemonic to memorize the Classic (Hakim’s) Triad of NPH Progression: “Wet, Wacky, Wobbly”: Incontinence, dementia, ataxia. Symptoms develop over the course of weeks to months, and brain imaging shows ventricular enlargement, which is disproportionate to the degree of cortical atrophy.

🔺 Neurosurgical ventriculoperitoneal shunt placement may correct the problem. Patients likely to benefit from shunt placement have a clear response to the removal of 30 to 40 mL of spinal fluid, with improved gait and alertness within minutes to hours of the procedure. The shunt diverts CSF from the brain or lumbar spinal sac to the abdominal cavity, where it is then absorbed into the circulation.

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