Normal Pressure Hydrocephalus (NPH)
Often misdiagnosed as Alzheimer’s or Parkinson’s disease, or as just a part of the normal aging process, normal pressure hydrocephalus (NPH) is a rare disorder that causes cognitive and physical symptoms — especially problems with gait and balance. In fact, according to the Hydrocephalus Association, nearly 700,000 adults in the United States are living with NPH and less than 20% have the diagnosis.
Getting the correct NPH diagnosis can help you or someone you love get back to living life the way you want. That’s why the expert and caring team at VCU Health provides evaluation and treatment for NPH, all under one roof.
What is normal pressure hydrocephalus?
NPH typically affects people in their 60s or 70s. It develops when cerebrospinal fluid begins to build up inside the head, putting pressure on the brain and causing symptoms like trouble walking, urinary incontinence (leakage) and cognitive issues like memory loss and confusion.
These symptoms usually get worse over time without treatment.
The NPH program at VCU Health
VCU Health is home to one of the first dedicated NPH programs in the world. The early work of the program’s founders — world-renowned research duo Harold Young, M.D., and Anthony Marmarou, Ph.D. — helped establish the global standard of care for the disorder.
Today, the program continues to serve as a leader in NPH, providing comprehensive evaluation, diagnostic and treatment options all under one roof. This one-stop shop feature isn’t offered at most major academic medical centers.
The NPH program team also isn’t siloed to only include neurosurgeons. It’s made up of neurologists, speech therapists, physical therapists, occupational therapists and urologists, too. They all work together with the neurosurgical providers to give you care that’s both multidisciplinary and personalized.
Evaluation and diagnosis of NPH
If your doctor suspects you may have NPH and refers you to us, we’ll perform a comprehensive evaluation.
We’ll first assess any problems with gait and balance you may have, considering other symptoms, too, like urinary incontinence and cognitive decline.
After the evaluation, if we believe you have NPH, we’ll perform a high-volume spinal tap. This procedure removes a large amount of cerebrospinal fluid from the spine to see if it helps your symptoms.
Treating NPH
Surgery is the standard treatment for NPH. If the spinal tap shows that removing extra fluid helps improve your gait and balance, it tells your doctor that your symptoms would respond even more to the surgical placement of a shunt, which is a tube inserted into the brain to drain fluid. Your doctor places a shunt by drilling a hole in the skull.
The CereVasc® eShunt® device
In recent years, VCU Health’s NPH team has helped lead the investigation of a new device designed to make the procedure for draining cerebrospinal fluid from the brain easier — and potentially safer.
Several VCU Health patients, including 69-year-old Bill Hobgood, have successfully received the eShunt device as part of a pilot study.
The staff has been great, from consultation to the diagnosis all the way through the procedure.
- Bill Hobgood, eShunt implant recipient
Instead of drilling a hole in the skull, the eShunt implant involves a tiny incision in the leg. Because the procedure is minimally invasive, there’s less risk of complications and infection.
The eShunt also doesn’t require any adjustments once it’s placed. A traditional shunt, however, requires multiple adjustments and multiple follow-up appointments.
VCU Health was the third highest-enrolling center in the pilot study, which included 12 medical centers around the country. It’s now the first medical center in the world activated for the pivotal trial of the device — the next phase in the trial process.
I’ve been here since 2008. I’ve been doing clinical trials since that time. There is no study that I’ve been as enthusiastic about as this one.
— John Reavey-Cantwell, M.D., Director of Cerebrovascular and Endovascular Neurosurgery
Disclaimer: The medical devices and treatments mentioned on this page are part of ongoing research and clinical trials. They are not yet approved for general use and should not be considered as endorsed products.
Additional NPH resources
Make an appointment
We can help you determine if you’re a good candidate for a shunt. Call (804) 827-4080 to schedule a consultation or to refer a patient.