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- Normal Pressure Hydrocephalus -

General Information:

Wikipedia entry:
Dr. Ray Shahelien entry: 


NPH (Normal Pressure Hydrocephalus)

See also CCSVI

Fluid in the ventricals (cavities) of the brain is not removed as it should causing the cavities to expand and press on the surrounding brain tissue.  This causes a host of mental problems that can be confused with AD or vascular dementia.  However, NPH is treatable with a shunt to carry away the fluid and restore normal pressure.  Unfortunately, most physicians don't look for this since it only affects about 5% of dementia suffers, and may not realize that this is the problem until too much damage has occured.  I must thank my mother in law for showing me an article about this disease that she cut out of the June 1, 2007 issue of Womans Day magazine.  If not for her, I would never have known about it.  Interestingly, a couple of weeks ago I had a chance to ask a woman who lives a few houses down the street from me about the condition of her mother.  We had found her wandering the streets a couple of time a few years ago, and were told that she had AD.  It turns out that a observant radiologist noticed that she in fact had NPH!   All those years she had been treated for AD.  But, much damage had been done by the time they put in the shunt.  Even though her symptoms did improve, she subsequently had a bad fall that cause serious head trauma, and she isn't doing so well.

Recently, I read an article that said that researchers had determined that injury to brain tissue could lead to AD.  The damaged and dying cells cause amyloid beta plaques to form.  The amyloid beta plaques are toxic to the healthy surrounding brain cells, and cause them to expire.  This domino effect, if left unchecked, can lead to full blown AD.  An interesting thought is, for people who have had a brain injury due to either stroke or head trauma, if a substance was administered that prevented the accumulation of amyloid beta, or even dissolved it, or at least made it non-toxic, would that be enough to halt the progression of injury related AD?  Hmmm.  Perhaps it would be a good idea to give brain injury patients 300 to 500 mg of curcumin on an empty stomach every day just to be on the safe side.  Since curcumin has no known side effects, is derived from the curry spice turmeric, and is not expensive; if there is a chance it works as well on humans as it does on mice, then it certainly would be a prudent thing to do.

In many countries with socialized medicine (such as Germany), there is an emphasis on diagnostics to determine who would be likely candidates for a ventriculoperitoneal shunt (i.e. a tube from the cavity in the brain to the gut).  There is no limit to the demand for healthcare, so there must some way to ration it.  In the U.S., it is rationed by who can pay for it.  In socialist countries, it is rationed by how valuable the recipient is to the state.  So, there is a lot of literature about how to diagnose NPH based on if the patient's symptoms improve during testing.  Not much, if anything, about how to halt the progressive decline of someone already suffering from the condition.

It is interesting to note that there is some disagreement about the root cause of the disease.  Most articles you will read mention the "reabsorption of the CSF by the subarachnoid villi", yet research shows that it is in fact the capillaries that do the absorbing.  Perhaps idiopathic (without a known cause) is actually a manifestation of high blood pressure, and could be treated in a similar manner???

Known sources:

Natural sources:


NPH (Normal Pressure Hydrocephalus)

Management of Normal Pressure Hydrocephalus

Case Western Reserve University, Cleveland, Ohio

"Gait instability, urinary incontinence, and dementia are the signs and symptoms typically found in patients who have normal pressure hydrocephalus. Estimated to cause no more than 5 percent of cases of dementia, ... often is treatable... Magnetic resonance imaging or computed tomography typically demonstrates ventricular dilation with preservation of the surrounding brain tissue. ... normal pressure hydrocephalus ... leading to an increase in ventricular size and encroachment of enlarged ventricles on adjacent brain tissue. The pressure exerted ... deforms white matter tracts, instigating gait abnormalities and incomplete control of the bladder, as well as difficulties in processing incoming stimulation and in producing expeditious responses..."

What is NPH?

"Normal Pressure Hydrocephalus is a neurological condition which normally occurs in adults 55-years and older. NPH is an accumulation of cerebrospinal fluid (CSF) causing the ventricles of the brain to enlarge, in turn, stretching the nerve tissue of the brain causing a triad of symptoms."


Paradigm shift in hydrocephalus research in legacy of Dandy’s pioneering work: rationale for third ventriculostomy in communicating hydrocephalus

Dan Greitz
Department of Neuroradiology, MR Research Center, Karolinska University Hospital, Stockholm, Sweden


"This study aims to question the generally accepted cerebrospinal fluid (CSF) bulk flow theory suggesting that the CSF is exclusively absorbed by the arachnoid villi and that the cause of hydrocephalus is a CSF absorption deficit. In addition, this study aims to briefly describe the new hydrodynamic concept of hydrocephalus and the rationale for endoscopic third ventriculostomy (ETV) in communicating hydrocephalus."

"The bulk flow theory has proven incapable of explaining the pivotal mechanisms behind communicating hydrocephalus. Thus, the theory is unable to explain why the ventricles enlarge, why the CSF pressure remains normal and why some patients improve after ETV."

Hydrodynamic concept of hydrocephalus
"Communicating hydrocephalus is caused by decreased intracranial compliance increasing the systolic pressure transmission into the brain parenchyma. The increased systolic pressure in the brain distends the brain towards the skull and simultaneously compresses the periventricular region of the brain against the ventricles. The final result is the predominant enlargement of the ventricles and narrowing of the subarachnoid space. The ETV reduces the increased systolic pressure in the brain simply by venting ventricular CSF through the stoma. The patent aqueduct in communicating hydrocephalus is too narrow to vent the CSF sufficiently."




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Updated: July 2, 2012
Inception: July 2, 2012