Diagnostics of idiopathic normal pressure hydrocephalus: literature review


  • Lyudmila Dzyak Dnepropetrovsk State Medical Academy, Dnepropetrovsk, Ukraine
  • Andriy Sirko Dnеpropetrovsk State Medical Academy, Dnepropetrovsk; Mechnikov Dnepropetrovsk Regional Clinical Hospital, Dnepropetrovsk, Ukraine https://orcid.org/0000-0001-6536-2035
  • Aleksandr Marchenko Dnepropetrovsk State Medical Academy, Dnepropetrovsk; Mechnikov Dnepropetrovsk Regional Clinical Hospital, Dnepropetrovsk, Ukraine
  • Ekaterina Mizyakina Dnepropetrovsk State Medical Academy, Dnepropetrovsk; Mechnikov Dnepropetrovsk Regional Clinical Hospital, Dnepropetrovsk, Ukraine




idiopathic normal pressure hydrocephalus, liquor pressure, ventriculomegaly, cognitive dysfunctions


In domestic and foreign literature data about morbidity and prevalence rates of idiopathic normal pressure hydrocephalus (INPH) are absent. This problem is due to lack of clear diagnostic criteria of this nosological form. The publication provides practical recommendations for establishing of INPH clinical diagnosis based on analysis of clinical trials results, conducted in Europe and USA, destined for early and accurate diagnostics, allowing to develop optimal treatment tactics and, ultimately, to improve outcomes and quality of treatment. It is recommended to classify INPH according to categories “probable”, “possible”, “unlikely”.


Krauss J.K. Normal pressure hydrocephalus: Survey on temporary diagnostic algorithms and therapeutic decision-making / J.K. Krauss, B.J. Halve // Acta Neurochir. — 2004. — V.146. — P.379–388.

HillM.E.A treatable form of dementia due to normal-pressure, communicating hydrocephalus / M.E. Hill, W.M. Lougheed // J. Can. Med. Assoc. — 1967. — V.97. — P.1309–1320.

Vanneste J.A. Diagnosis and management of NPH / J.A. Vanneste // J. Neurol. — 2000. — V.247. — P.5.

Verres M. Management of NPH / M. Verres, W.R. Selman // Am. Fam. Phys. — 2004. — V.70. — P.1071–1078.

Bradley W.G. Normal pressure hydrocephalus: New concepts on etiology and diagnosis / Am. J. Neuroradiol. — 2000. — V.21. — P.1586.

Hebb A.O. Idiopathic normal pressure hydrocephalus: A systematic review of diagnostic and outcome/ A.O. Hebb, M.D. Cusimano // J. Neurosurg. — 2001. — V.49. — P.1166–1184.

Wilson J.A. Normal pressure hydrocephalus / J.A. Wilson, O. Islam [Електронний ресурс]. — Режим доступу до статті: http://emedicine.medscape.com/article/342827-overview.

Psychiatric manifestations of normal-pressure hydrocephalus: A short review and unusual case / G. Pinner, H. Johnson, W.P. Bouman [et al.] // Int. Psychogeriatr. — 1997. — V.9. — P.465–470.

Fisher C. The clinical picture of occult hydrocephalus / C. Fisher // Clin. Neurosurg. — 1977. — V.24. — P.270–284.

Hakim S. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: Observations on cerebrospinal fluid dynamics / S. Hakim, R.D. Adams // J. Neurol. Sci. — 1965. — V.2. — P.307–327.

The value of clinical findings in the detection of normal pressure hydrocephalus / C. Mulrow, J.R. Feussner, B.C. Williams [et al.] // J. Gerontol. — 1987. — V.42. — P.277–279.

Crowell R. Aggressive dementia associated with normal pressure hydrocephalus: Report of two unusual cases / R. Crowell, J.M. Tew, V.H. Mark // Neurology. — 1993. — V.23. — P.461–464.

Borgesen S.E. Intracranial pressure and conductance to outflow of cerebrospinal fluid in normal pressure hydrocephalus / S.E. Borgesen, F. Gjerris, S.C. Sorensen // J. Neurosurg. — 1979. — V.50. — P.489–493.

Abbruzzese M. Obsessive-compulsive symptomatology in normal pressure hydrocephalus. A case report / M. Abbruzzese, S. Scarone,Colombo// J. Psychiatr. Neurosci. — 1994. — V.19. — P.378–380.

Shunting effects in patients with idiopathic normal pressure hydrocephalus: Correlation with cerebral and leptomeningeal biopsy findings / R.A. Bech, G. Waldemar, F. Gjerris [et al.] // Acta Neurochir. (Wien). — 1999. — V.141. — P.633–639.

Jonas S. Neurogenic bladder in normal pressure hydrocephalus / S. Jonas, J. Brown // Urology. — 1975. — V.5. — P.44–50.

Evans W.A. An encephalographic ratio for estimating ventricular and cerebral atrophy / W.A. Evans // Arch. Neurol. Psychiatry. — 1942. — V.47. — P.931–937.

Black P.L. Idiopathic normal pressure hydrocephalus: Results of shunting in 62 patients / P.L. Black // J. Neurosurg. — 1980. — V.52. — P.371–377.

Further experiences with the syndrome of normal pressure hydrocephalus / R.G. Ojemann, C.M. Fisher, R.D. Adams [et al.]// J. Neurosurg. — 1969. — V.31. — P.279–294.

Movement disorders in adult hydrocephalus / J. Krauss, J.P. Regel, D.W. Droste [et al.] // Mov. Disord. — 1997. — V.12. — P.53–60.

Postural disturbance in patients with normal pressure hydrocephalus / E. Blomsterwall, U. Svantesson, U. Carlsson [et al.] // Acta Neurol. Scand. — 2000. — V.102. — P.284–291.

Motor evoked potentials in the preoperative and postoperative assessment of normal pressure hydrocephalus/ M. Zaaroor,N. Bleich, A. Chistyakov [et al.]// J. Neurol. Neurosurg. Psychiat. — 1997. — V.62. — P.517–521.

Knutsson E. Gait apraxia in normal-pressure hydrocephalus: Patterns of movement and muscle activation /E. Knutsson, U. Lying-Tunell // Neurology. — 1985. — V.35. — P.155–160.

Sudarsky L. Gait disorder in late-life hydrocephalus / L. Sudarsky, S. Simon // Arch. Neurol. — 1987. — V.44. — P.263–267.

Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson’s disease / H. Stolze, J.P. Kuhtz-Buschbeck, H. Drucke [et al.] // J. Neurol. Neurosurg. Psychiat. — 2001. — V.70. — P.289–297.

Resistance to cerebrospinal fluid outflow in patients with normal pressure hydrocephalus / F. Gjerris, S.E. Borgesen, J. Schmidt [et al.]; ed. F. Gjerris, S.E. Borsegen, P.S. Sorensen // Outflow of cerebrospinal fluid.Copenhagen: Munksgaard, 1989. — P.329–338.

Gait analysis in idiopathic normal pressure hydrocephalus: Which parameters respond to the CSF tap test? / H. Stolze, J.P. Kuhtz-Buschbeck, H. Drucke [et al.] // Clin. Neurophysiol. — 2000. — V.111. — P.1678–1686.

Merten T. Neuropsychology of normal pressure hydrocephalus [in German] / T. Merten // Nervenarzt. — 1999. — Bd.70. — S.496–503.

Obesity does not cause abnormal CSF pressure in subjects with normal MRV / F. Bono, M.R. Lupo, P. Serra [et al.] // Neurology. — 2002. — V.59. — P.1641–1643.

Rosen H. Depression and normal pressure hydrocephalus: A dilemma in neuropsychiatric differential diagnosis / H. Rosen, M. Swigar// J. Nerv. Ment. Dis. — 1976. — V.163. — P.35–40.

Bekkelund S. Reversible dementia in idiopathic normal pressure hydrocephalus: A case report /S. Bekkelund, T. Marthinsen, T. Harr // Scand. J. Prim. Health Care. — 1996. — V.17. — P.22–24.

Mood cycles associated with normal pressure hydrocephalus / U. Schneider, A. Malmadier, R. Dengler [et al.] // Am. J. Psychiat. — 1996. — V.153. — P.1366–1367.

McIntyre A. Shoplifting associated with normal-pressure hydrocephalus: Report of a case / A. McIntyre, R. Emsley // J. Geriatr. Psychiat. Neurol. — 1990. — V.3. — P.229–230.

Bloom K. Paranoia: An unusual presentation of hydrocephalus / K. Bloom, W. Kraft // Am. J. Phys. Med. Rehabil. — 1998. — V.77. — P.157–159.

Lying-Tunell U. Psychotic symptoms in normal-pressure hydrocephalus / U. Lying-Tunnel // Acta Psychiatr. Scand. — 1979. — V.59. — P.415–419.

Falling spells in normal pressure hydrocephalus: A favourable prognostic sign? / J. Haan, E.N. Jansen, J. Oostrom [et al.] // Eur. Neurol. — 1987. — V.27. — P.216–220.

Restructuring the sleep of a patient with NPH (normal pressure hydrocephalus) after ventricular CSF shunt / C. Munari, F. Calbucci, W. Dallolio [et al.] // Riv. Neurol. — 1977. — V.47. — P.259–266.

Mysiw W. Relationship of new-onset systemic hypertension and normal pressure hydrocephalus/ W. Mysiw, R. Jackson // Brain Injury. — 1990. — V.4. — P.233–238.

Chronic hydrocephalus presenting with bilateral ptosis after minor head injury: Case report / H. Suzuki, T. Matsubara, K. Kanamaru [et al.] // Neurosurgery. — 2000. — V.47. — P.977–980.

Syndrome of inappropriate secretion of antidiuretic hormone associated with idiopathic normal pressure hydrocephalus / M. Yoshino, Y. Yoshino, M. Taniguchi [et al.] // Intern. Med. — 1999. — V.38. — P.290–292.

Bret P. Is normal pressure hydrocephalus a valid concept in 2002? A reappraisal in five questions and proposal for a new designation of the syndrome as “chronic hydrocephalus” / P. Bret, J. Guyotat, J. Chazal // J. Neurol. Neurosurg. Psychiat. — 2002. — V.73. — P.9–12.

Graff-Radford N.R. Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly / N.R. Graff-Radford, J.C. Godersky, M.P. Jones // Neurology. — 1989. — V.39. — P.1601–1604.

Diagnosing idiopathic normal-pressure hydrocephalus/ N. Relkin, A. Marmarou, P. Klinge [et al.] // Neurosurgery. — 2005. — V.57, N3. — P.2–16.



How to Cite

Dzyak, L., Sirko, A., Marchenko, A., & Mizyakina, E. (2011). Diagnostics of idiopathic normal pressure hydrocephalus: literature review. Ukrainian Neurosurgical Journal, (4), 10–17. https://doi.org/10.25305/unj.57561



Review articles