Idiopathic Normal Pressure Hydrocephalus Management and Diagnostic Techniques

Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible syndrome manifesting as gait disturbance, cognitive impairment and urinary incontinence in the context of normal cerebrospinal fluid (CSF) opening pressure. Neuroimaging reveals ventriculomegaly often accompanied by disproportionately enlarged subarachnoid-space hydrocephalus, tight high-convexity sulci and a reduced callosal angle. Diagnostic assessment integrates structural MRI markers with dynamic CSF tests—such as the CSF tap test, continuous intracranial pressure monitoring and infusion studies—and functional imaging modalities including phase-contrast MRI and FDG PET to distinguish iNPH from mimicking neurodegenerative disorders. Management is centred on CSF diversion via ventriculoperitoneal or lumboperitoneal shunts equipped with programmable valves, optimised through advances in biomaterials and valve technology to reduce complications and tailor pressure settings. Consideration of comorbidities and multimodal diagnostic data has improved patient selection and prognostication, while emerging research into fluid biomarkers, glymphatic function and advanced imaging analytics aims to refine diagnostic accuracy and guide novel therapeutic strategies.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Idiopathic Normal Pressure Hydrocephalus Management and Diagnostic Techniques publication trend

The graph below shows the total number of articles in idiopathic normal pressure hydrocephalus management and diagnostic techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Idiopathic normal pressure hydrocephalus (iNPH): A syndrome of enlarged cerebral ventricles with normal CSF pressure, characterised by gait disturbance, cognitive decline and urinary incontinence.

Disproportionately enlarged subarachnoid-space hydrocephalus (DESH): An MRI pattern combining ventriculomegaly with tight high-convexity sulci and dilated Sylvian fissures.

Callosal angle: The angle between the lateral ventricles on a coronal MRI slice, reduced in iNPH and predictive of shunt responsiveness.

Evans index: The ratio of maximal frontal horn width to maximal cranial width, used to quantify ventricular enlargement.

Cerebrospinal fluid tap test (CSF tap test): A diagnostic procedure involving removal of a small CSF volume via lumbar puncture to assess transient symptom improvement.

Ventriculoperitoneal shunt: A surgical device that diverts CSF from the cerebral ventricles to the peritoneal cavity to alleviate hydrocephalus.

References

1. A Male Patient with Hydrocephalus via Multimodality Diagnostic Approaches: A Case Report. Cyborg and Bionic Systems (2024).
2. The metabolic spatial covariance pattern of definite idiopathic normal pressure hydrocephalus: an FDG PET study with principal components analysis. Alzheimer's Research & Therapy (2023).
3. Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus. CNS Neuroscience & Therapeutics (2020).