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Diagnosing Normal Pressure Hydrocephalus (NPH)
Often times the cause of Normal Pressure Hydrocephalus (NPH) cannot be determined. In a few cases it can be associated with a previous head injury or surgery. The best way to diagnose patients presenting with the triad of symptoms is to have them referred to a neurosurgeon. The first step to diagnosing NPH is a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan which can show the build-up of fluid, and a thorough history and neurological assessment. An additional evaluation by a qualified neurologist may also be recommended at this time. If NPH is still suspected after the initial neurosurgical consultation, a multidisciplinary team including a physical therapist, a speech therapist, and a neuropsychologist will evaluate the patient to determine if a more invasive external lumbar drainage test would impact the symptoms.
External lumbar drainage
New medical guidelines suggest that this test may help determine which patients are most likely to benefit from NPH treatment. The lumbar drain has been found to be the best predictor of whether a patient will improve through treatment or not. An inpatient procedure running the course of 3-4 days, the external lumbar drain is placed in the spine and a small volume of fluid is drained daily from the back in order to reduce the amount of CSF around the brain. Each day the patient’s gait (ability to walk), cognitive processes (ability to think), and incontinence will be measured and analyzed independently by nurses, physical therapists, speech therapists, neuropsychologists, and rehabilitation specialists. Any improvement in symptoms with this procedure is highly suggestive that an operation to insert a shunt would be beneficial.
In some patients, this test may be done on an outpatient basis. External lumbar drainage is "simulated" by performing a series of lumbar punctures at which a relatively high volume of CSF is withdrawn.