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Hydrocephalus & Normal Pressure Hydrocephalus

Hydrocephalus Verified · Sep 2026

NINDS: "Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) deep within the brain. This excess fluid causes the ventricles (cavities) within the brain to widen, putting harmful pressure on the brain's tissues." StatPearls: "Idiopathic normal pressure hydrocephalus (iNPH), represented by the ICD-10 code of G91.2, is the most common form of hydrocephalus in adults and is a potentially reversible cause of dementia."

CSF is made in the ventricles, flows through narrow channels and is absorbed into the venous sinuses; block or slow any step and the ventricles enlarge. In an older adult, a shuffling, "glue-footed" gait with urinary urgency and slowed thinking should prompt a look for NPH, because a shunt can help — gait most of all. For every shunted patient, the nurse teaches the family the warning signs of shunt failure; for every EVD, the nurse keeps the drain levelled to the ear and clamped for transport.

What’s going wrong in the body

The normal physiology, where it fails, and why the body’s compensation backfires.

01 CSF: made, moved, absorbed — and the fixed skull

"CSF protects and cushions the brain and spine" (NINDS). "CSF is chiefly produced by the choroid plexus, which is located within the lateral, third, and fourth ventricles." It flows from the lateral to the third ventricle through the foramen of Monro and on to the fourth ventricle through the aqueduct of Sylvius. "The main sites of CSF absorption are arachnoid granulations that projects into dural venous sinuses, especially superior sagittal sinus" (StatPearls).

Volume. "The average CSF volume is approximately 150 ml, and the daily production is about 500ml. This means that the total CSF volume is replaced three times per 24hours" (StatPearls) — so a blocked system fills quickly.

Monro–Kellie. "According to the Monro-Kellie doctrine, the total volume of the brain, CSF, and blood within the skull is constant. An increase in one compartment must accompany a decrease in volume in another compartment; otherwise, the pressure within the head will be increased, as happens in hydrocephalus." Raised pressure pushes CSF into brain tissue, "causing brain damage and pressure-induced atrophy" (StatPearls).

A block anywhere along the pathway causes obstructive hydrocephalus; failed absorption causes communicating hydrocephalus. Either way, fluid builds up in a fixed skull.

02 Types — and acute hydrocephalus as an emergency

Obstructive (non-communicating). "Obstructive hydrocephalus develops from a block in CSF pathways." "Posterior fossa tumors are commonly associated with the development of hydrocephalus" (StatPearls).

Communicating. "Communicating hydrocephalus is caused by impaired absorption of CSF. The most common causes are post hemorrhagic or post-inflammatory changes. Subarachnoid hemorrhage accounts for one-third of these cases by blocking CSF absorption at the arachnoid granulations." "Meningitis, especially bacterial, can be complicated with hydrocephalus" (StatPearls). In adults StatPearls lists four types: "obstructive, communicating, hypersecretory, and normal pressure hydrocephalus (NPH)." Enlarged ventricles from brain shrinkage after stroke or injury are "not a true hydrocephalus but a hydrocephalus “look-alike” condition" (NINDS).

Acute hydrocephalus. "Acute hydrocephalus is a life-threatening condition and can result in brain herniation, transtentorial herniation of temporal lobe or herniation of the cerebellum into the foramen magnum, with the clinical picture of a dilated and nonreactive ipsilateral pupil, autonomic dysfunction, loss of brain stem reflexes and coma. It requires immediate neurosurgical intervention to relieve the pressure" (StatPearls). In acute hydrocephalus, an external ventricular drain "is the most common procedure performed in these cases" (StatPearls).

Infants (one line). "Babies may be born with hydrocephalus (called congenital hydrocephalus) or develop the condition shortly after birth" (NINDS); a rapidly enlarging head and a bulging fontanel are the infant signs.

Acute hydrocephalus is a medical emergency: rising pressure leads to herniation unless CSF is drained (StatPearls).

03 Normal pressure hydrocephalus — a slow, treatable cause of gait and memory decline

"Normal pressure hydrocephalus (NPH) is a condition characterized by a symptomatic communicating hydrocephalus, with cerebrospinal fluid pressure often within the conventionally defined normal range" (StatPearls). NINDS: "The increase in cerebrospinal fluid in NPH happens slowly enough that the tissues around the ventricles compensate and the fluid pressure inside the head does not increase." It may be idiopathic or follow hemorrhage, head trauma, infection, tumor or surgery. "The average age at symptom onset approximates 70 years" (StatPearls).

Why the triad. Enlarging ventricles stretch nearby fibers. "Gait abnormalities arise from stretching and compression of corticospinal tract fibers within the corona radiata supplying the lower extremities, which course adjacent to the lateral ventricles." Bladder dysfunction comes from "loss of supraspinal inhibition of detrusor contractions." Ventricular enlargement also "generates radial shearing forces" on the cortex, "leading to cognitive decline and dementia" (StatPearls).

Gait comes first — and improves most. "Gait disturbance commonly represents the earliest and most frequent presenting symptom and often shows the most rapid postoperative improvement." "Cognitive and urinary outcomes are more variable and are strongly influenced by comorbid neurodegenerative disease burden" (StatPearls). "Without treatment, NPH symptoms may worsen and cause death" (NINDS).

NPH: slow ventricular enlargement at near-normal pressure produces the gait–bladder–cognition triad; gait responds best to a shunt (StatPearls).

Causes & risk factors

Modifiable factors are teaching targets — the patient can act on them.

Brain or spinal cord tumors — posterior fossa tumors are commonly associated (NINDS, StatPearls) Bleeding in the brain — subarachnoid hemorrhage accounts for one-third of communicating cases (StatPearls); intraventricular hemorrhage Central nervous system infection — especially bacterial meningitis Head injury or stroke Older age (NPH) — average onset around 70 years; iNPH accounts for an estimated 6% of dementia cases (StatPearls) Congenital malformations; prematurity with intraventricular hemorrhage (infants — one line)

Signs & symptoms

Each finding tied to the mechanism that produces it — and the triage it calls for.

[HYD] Headache, nausea or vomiting, blurred or double vision, sleepiness, balance problems early Hold & notify
Why: NINDS symptom list for adults and older children; StatPearls adds "explosive vomiting," neck pain, irritability, seizures and confusion — signs of rising intracranial pressure.
[HYD] Decreasing consciousness, a dilated nonreactive pupil, autonomic changes, coma Report immediately
Why: StatPearls: acute hydrocephalus "is a life-threatening condition" with herniation, and "It requires immediate neurosurgical intervention to relieve the pressure." "Acute hydrocephalus is a medical emergency."
[NPH] Gait disturbance — shuffling, wide-based, "magnetic" steps; trouble turning; freezing early
Why: StatPearls: gait disturbance is "the earliest and most frequent presenting symptom." Progressive disease brings "slow speed, short steps, broad-based stance, and a glue-footed or astasia–abasia pattern." Muscle strength is usually normal.
[NPH] Urinary urgency, frequency or incontinence
Why: StatPearls: "Urinary symptoms arise primarily from detrusor overactivity, producing urinary frequency, urgency, or frank incontinence."
[NPH] Slowed thinking, forgetfulness, poor executive function, apathy late
Why: StatPearls: "Cognitive impairment in iNPH reflects a subcortical dementia pattern characterized by inertia, forgetfulness, and impaired executive function." "Apathy frequently accompanies cognitive decline."
[NPH] Worsening gait with falls, new incontinence or faster cognitive decline Hold & notify
Why: StatPearls: untreated NPH brings "progressive gait impairment with falls, loss of independence, and complications of immobility"; rapid progression over weeks to months should prompt a search for another cause.
[SHUNT] Headache, double vision or light sensitivity, vomiting, neck or shoulder soreness, seizures, redness or tenderness along the shunt tract, low-grade fever, sleepiness, return of hydrocephalus symptoms Report immediately
Why: NINDS: "People should seek medical help immediately if symptoms develop that suggest the shunt system is not working properly." FDA: "medical attention should be sought immediately." Malfunction lets CSF build up again, which "can increase the intracranial pressure resulting in cerebral edema and ultimately herniation" (StatPearls).
[VALVE] New headache after an MRI or close magnet exposure (programmable valve) Hold & notify
Why: FDA: "Unintended changes in shunt valve setting are usually not life-threatening. Headache is often the first symptom when a shunt is not draining properly." The valve setting needs checking. If other shunt-failure signs appear, treat it as the emergency above.

Diagnostics

Test In this disorder Normal
[HYD] Emergency head CT StatPearls: "In cases of acute hydrocephalus, an emergency head computed tomographic (CT) scan is the first option to assess the ventricular size." NINDS: "Doctors may use CT in an emergency situation." Enlarged ventricles —
MRI of the brain StatPearls: MRI "is the study of choice as it shows better the posterior fossa structures, can differentiate between brain tumors and degenerative diseases and can differentiate NPH from cerebral atrophy." In iNPH an Evans index of 0.30 or greater supports ventricular enlargement, "although values of 0.30 or less do not exclude iNPH." Ventriculomegaly; in iNPH, enlarged Sylvian fissures with tight high-convexity sulci —
[NPH] Large-volume lumbar tap test StatPearls (iNPH): typically 30 to 50 mL removed, with assessment "at 2 to 4 hours and again the following day"; StatPearls (Hydrocephalus) cites 40–50 mL. "A negative tap test does not exclude iNPH." Opening pressure is often normal: "a single normal lumbar puncture does not exclude the diagnosis." If the tap test is equivocal, "External lumbar drainage may be considered." Gait improves after CSF removal (positive test) StatPearls —
[NPH] Timed gait and turning measures, before and after the tap StatPearls: "Objective gait metrics, including the Timed Up and Go test, gait speed, and number of steps required to turn, should be recorded alongside a brief cognitive assessment emphasizing executive function." "A reduction of approximately 5 seconds on the Timed Up and Go test supports responsiveness, although clinical judgment predominates." Faster Timed Up and Go, fewer steps to turn —
[HYD] Fundoscopic examination NINDS: it "can show evidence of swelling that indicates elevated pressure in the skull, which may suggest hydrocephalus." Optic nerve swelling if pressure is raised —
[VALVE] Valve setting check FDA: "The only sure way to know if an adjustable shunt valve setting has changed is to have the pressure setting checked by a physician with an X-ray or specialized magnetic tool known as a shunt checker." Setting unchanged after MRI or magnet exposure FDA —

Complications

Black-box warning — most severe: ■ [HYD] Herniation from acute hydrocephalus Report immediately
"Acute hydrocephalus without prompt treatment can result in brain herniation and death" (StatPearls).
Watch for a falling level of consciousness, a dilated nonreactive pupil, autonomic dysfunction and loss of brainstem reflexes. "It requires immediate neurosurgical intervention to relieve the pressure."
Warning: [SHUNT] Shunt malfunction and underdrainage Report immediately
"Shunt malfunction is most commonly due to a blockage or some obstruction within the shunt system. If the blockage is not corrected, symptoms of hydrocephalus will return" (FDA). "A person may need multiple surgeries to repair or replace a shunt throughout their lifetime" (NINDS).
Catheters can calcify, break or disconnect, and valves can stick (FDA). "The complications usually cluster in the first postoperative year and then decline" (StatPearls, iNPH).
Warning: [SHUNT] Shunt infection Report immediately
"Infection from a shunt may produce symptoms such as a low-grade fever, soreness of the neck or shoulder muscles, and redness or tenderness along the shunt tract" (FDA).
StatPearls: infection is usually from skin flora, "usually from Staphylococcus epidermidis," and "The abdomen has to be monitored for peritonitis secondary to shunt infection." Some patients need antibiotic prophylaxis before dental or invasive procedures.
Warning: [SHUNT] Overdrainage — subdural hematoma, slit ventricles Hold & notify
"Overdraining can cause the ventricles to collapse, tearing blood vessels and causing headaches, hemorrhages (subdural hematomas), or a condition where the ventricles decrease in size until they are too small (slit ventricle syndrome)" (FDA).
In NPH, overdrainage shows as "orthostatic headache, nausea, or slit ventricles" (StatPearls). Programmable valves start at a higher opening pressure and are lowered stepwise, "minimizing the risk of subdural effusions and overdrainage-related symptoms."
Warning: [EVD] Overdrainage, infection and blockage of an external ventricular drain Report immediately
Overdrainage "can lead to aneurysmal rebleed and, in hydrocephalus, superior transtentorial herniation." "Infection is the most common complication of external ventricular drainage (EVD), with rates ranging from 0% to 45%" (StatPearls).
"No single intervention successfully prevents infection; however, limiting the duration of ventricular catheterization is the most effective." Obstruction "by air, blood, and debris is common, leading to false ICP recordings" (StatPearls).
Caution: [NPH] Untreated NPH Hold & notify
"Without treatment, patients often develop progressive gait impairment with falls, loss of independence, and complications of immobility. Urinary dysfunction increases the risk of incontinence-associated dermatitis and urinary tract infections. Cognitive decline can progress to dementia-level functional dependence" (StatPearls).

Medications for this condition

Why each class is prescribed here — every card links to its full pharmacology page.

Diuretics
Cardiovascular

Acetazolamide (a carbonic anhydrase inhibitor) — narrow role. StatPearls: it "decreases CSF secretion by the choroid plexus and hence used in the treatment of hydrocephalus. It is mostly used in pseudotumor cerebri." In NPH, "Carbonic anhydrase inhibitors and serial drainage lumbar punctures have a role only in nonsurgical candidates." Surgery, not medicine, is the main treatment. No doses here.

Beyond medications

  • [HYD] Surgery is the main treatment. "The most common treatment for hydrocephalus is surgery" (NINDS). A shunt drains CSF "into either the chest cavity or the abdomen so the body can absorb it"; "Ventriculoperitoneal (VP) shunt is the most common type of shunt" (StatPearls). Treating the cause — for example removing a tumor or clot — may resolve it.
  • [HYD] Endoscopic third ventriculostomy (ETV) makes a small opening in the floor of the third ventricle so CSF can bypass a block; it "is commonly used in cases of aqueductal stenosis to prevent a permanent shunt" (StatPearls). It is not routine therapy for classic iNPH.
  • [HYD] Acute hydrocephalus: external ventricular drain — "the most common procedure performed in these cases" (StatPearls).
  • [NPH] Shunt with a programmable valve. "Shunt surgery is the primary disease-modifying treatment for iNPH." StatPearls describes starting at a higher opening pressure "followed by stepwise reduction guided by gait improvement and imaging changes." "The valve should be reprogrammed when symptoms persist or recur, or when overdrainage symptoms occur."
  • [VALVE] MRI and magnets. "Patients with CSF shunts should inform their health care providers prior to receiving MRI due to the potential of the MRI magnetic field to change their implanted device" (FDA). Valves are checked and reset after MRI, and FDA recommends keeping magnets — including hearing devices that use magnets — some distance from magnetically adjustable valves.
  • [NPH] Rehabilitation — physical therapy "focused on gait initiation, turning, and balance" (StatPearls); rehabilitation and educational interventions benefit many people with hydrocephalus (NINDS).

Nursing considerations

The RN-specific layer — each action paired with the reason it matters.

Assessment
Do frequent neurological checks — level of consciousness, pupils, headache, vomiting — in any patient with acute hydrocephalus, an EVD or a new shunt.
Why: Acute hydrocephalus can progress to herniation with "a dilated and nonreactive ipsilateral pupil" and coma (StatPearls); "Frequent neurological assessments" are part of EVD monitoring (StatPearls, citing SNACC).
[NPH] Record timed gait, steps to turn and a brief cognitive screen before and after a tap test, at 2–4 hours and the next day.
Why: StatPearls: objective gait metrics decide whether the tap test is positive; "Observed improvement in gait quality and safety defines a positive response."
[SHUNT] Inspect the shunt tract and abdomen for redness, swelling or tenderness, and check temperature.
Why: StatPearls: look for "redness or swelling along the shunt tubing" and monitor the abdomen for peritonitis; FDA lists low-grade fever and tract redness as infection signs.
[EVD] Record CSF drainage hourly, and check oscillation in the tubing, the waveform, the drain height, the dressing and the system for leaks.
Why: StatPearls, citing SNACC: "Hourly CSF drainage" "Oscillation of CSF within the tubes" "Absence of wound seepage" "Correct height of the EVD"; a damped waveform or absent flow suggests blockage (EVD review, Surg Neurol Int).
[NPH] Assess fall risk, continence and skin in older adults with NPH.
Why: Untreated NPH brings falls, "incontinence-associated dermatitis and urinary tract infections" (StatPearls).
Interventions
[EVD] Level the drain to the tragus / external auditory meatus (foramen of Monro) and re-level with every position change.
Why: EVD review (Surg Neurol Int): the system "must be re-leveled whenever the patient changes position to avoid erroneous ICP reading and/or over or under drainage." The reference point is the ear, not the chest.
[EVD] Clamp the drain for transfer and transport (and per protocol for other activities); unclamp and re-level on return.
Why: "drain should also be clamped during transfer and transport" (EVD review). Overdrainage can cause aneurysmal rebleeding and herniation (StatPearls).
[EVD] Use strict aseptic technique with the drain; if CSF sampling meets resistance, stop and notify the provider immediately.
Why: Infection is the most common EVD complication, and "Frequent CSF sampling (each sampling increases the risk by 8.3%)" (StatPearls). EVD review: "if any resistance is met, the procedure should be aborted and a physician should be notified immediately."
[EVD] After drain removal, monitor closely for at least 24 hours for deterioration.
Why: StatPearls: close monitoring "for at least 24 hours after removal, with preparations in place for the emergency reinsertion."
[SHUNT] For any shunt-failure sign, escalate at once.
Why: NINDS/FDA: shunt-failure signs need medical help "immediately"; StatPearls: "Any unusual finding by the primary physician has to be immediately reported back to the neurosurgeon."
[NPH] Put fall precautions in place, and support physical therapy for gait initiation, turning and balance.
Why: Gait disturbance is the earliest symptom and falls are common (StatPearls).
Patient and family teaching
Seek medical help immediately for headache, double vision or light sensitivity, vomiting, neck or shoulder soreness, seizures, redness or tenderness along the shunt, low-grade fever, sleepiness, or return of the original symptoms.
Why: NINDS shunt-failure list; StatPearls: knowing these signs "is mandatory for patients and their families to look for emergent medical support."
Know your shunt type, carry the information, and tell every provider about the shunt before an MRI.
Why: FDA: "Knowing the shunt type can help you get appropriate treatment if a shunt-related problem occurs"; MRI can change a programmable valve.
After an MRI, have a programmable valve checked and reset, and keep magnets away from the valve.
Why: FDA: early detection comes from "checking and resetting valves following MRIs, and understanding the symptoms of over or underdrainage."
Protect the valve and tubing from injury and scratching; ask about antibiotic prophylaxis before dental or invasive procedures.
Why: StatPearls: avoid damaging the "superficially positioned valve and tubing system," and "Some patients require antibiotic prophylaxis for dental or other invasive procedures."
[NPH] After shunt surgery, report wound problems, confusion or new weakness, and seek help immediately for fever or a new headache (possible shunt failure, as above) — and expect gait to improve first.
Why: StatPearls: "patients should seek medical advice if they have any wound-healing issues, fever, new headaches, confusion, or focal deficits"; gait shows "the highest probability and the earliest timing of benefit."

How a real nurse thinks

The clinical-judgment loop, worked for a typical presentation — reasoning, not reference.

  1. 1
    Recognize cues

    A new headache that is worse upright with nausea after shunting; a planned MRI in a patient with a programmable valve; gait already improving.

  2. 2
    Analyze cues

    Orthostatic headache and nausea match NPH overdrainage ("orthostatic headache, nausea, or slit ventricles"), which can lead to subdural hematoma. Headache is also a shunt-failure sign on the NINDS list. MRI can change a programmable valve setting. Improving gait is the expected early response.

  3. 3
    Prioritize

    Report the headache now and keep up neuro checks for signs of a subdural bleed or shunt failure; flag the shunt before the MRI so the valve is checked afterward.

  4. 4
    Generate solutions

    Notify the neurosurgeon of the orthostatic headache and nausea; repeat neuro checks; tell the MRI team and provider about the programmable valve; plan a valve check and reset after the MRI; continue fall precautions and gait therapy.

  5. 5
    Take action

    Calls the surgeon; documents neuro checks; places a shunt alert on the MRI order; teaches the patient and his wife the shunt-failure signs that need immediate help.

  6. 6
    Evaluate

    Checks that the headache settles after any valve adjustment, that neuro checks stay stable, that the valve setting is confirmed after the MRI, and that gait keeps improving.

Scenario — you’re the nurse

Work each question before revealing the answer. Rationales explain the wrong options too.

Neurosurgery unit · day 2 after a VP shunt for NPH, 0800

A 76-year-old man had 18 months of worsening walking, urinary urgency and forgetfulness. A lumbar tap test improved his gait, and a VP shunt with a programmable valve was placed yesterday.

Gait — still wide-based, but he turns in fewer steps than before surgery
Morning — new headache when sitting up, better lying flat; mild nausea
Neuro — alert and oriented; pupils equal and reactive
Wound — dry, no redness along the tubing; T 37.0 °C
Plan — MRI of the spine ordered for chronic back pain
Q1 Select all that apply
Which findings fit the classic triad of normal pressure hydrocephalus? Select all that apply.
  1. A. Wide-based, shuffling gait
  2. B. Urinary urgency or incontinence
  3. C. Slowed thinking and forgetfulness
  4. D. Raised opening pressure on lumbar puncture
  5. E. Severe headache with papilledema
Reveal answer & rationale
Answer: A, B, C
The Hakim triad is "gait problems, dementia, and urinary incontinence" (StatPearls) (A, B, C). NPH pressure is often "within the conventionally defined normal range" (D). "Severe headache with papilledema" is a red flag for a raised-pressure syndrome, not NPH (E).
Q2 Multiple choice
The family of a patient with a VP shunt calls because he has a headache, has vomited twice and is unusually sleepy. What should the nurse advise?
  1. A. Give acetaminophen and call back if it lasts 2 days
  2. B. Seek medical help immediately — these may be signs of shunt failure
  3. C. Have him lie flat and recheck in 4 hours
  4. D. Wait for the next scheduled shunt check
Reveal answer & rationale
Answer: B
NINDS: "People should seek medical help immediately if symptoms develop that suggest the shunt system is not working properly," listing headache, nausea or vomiting and sleepiness (B). Waiting (A, C, D) delays care for possible shunt failure, which can raise pressure and lead to herniation.
Q3 Multiple choice
A patient with an external ventricular drain is going to CT. What should the nurse do with the drain?
  1. A. Leave it open and lower it to the floor
  2. B. Clamp it for transport, then re-level at the tragus and unclamp on return as ordered
  3. C. Remove it before transport
  4. D. Level it to the phlebostatic axis for the trip
Reveal answer & rationale
Answer: B
EVD review: "drain should also be clamped during transfer and transport," and the system is levelled to the foramen of Monro at the ear and re-levelled after position changes (B). Leaving it open and off-level breaks the clamp-for-transport rule and risks over or under drainage; overdrainage can cause rebleeding and herniation (A). Removing the drain is not a transport step (C). The EVD reference point is the ear, not the chest (D).
Q4 Multiple choice
A patient with a programmable shunt valve is scheduled for an MRI. Which teaching is correct?
  1. A. MRI has no effect on shunt valves
  2. B. Tell the provider about the shunt, and have the valve setting checked after the MRI
  3. C. The shunt must be removed before any MRI
  4. D. Only CT scans can affect the valve
Reveal answer & rationale
Answer: B
FDA: patients "should inform their health care providers prior to receiving MRI due to the potential of the MRI magnetic field to change their implanted device," and valves should be checked and reset after MRI (B). MRI can change the setting (A). Removal is not required (C). The risk is from magnetic fields, not CT (D).
Q5 Multiple choice
An older adult with suspected NPH has a normal lumbar opening pressure and no gait change after one tap test. What is the best interpretation?
  1. A. NPH is ruled out
  2. B. NPH is not excluded; extended lumbar drainage may be considered if suspicion persists
  3. C. The patient needs acetazolamide as first-line treatment
  4. D. The normal pressure proves the diagnosis
Reveal answer & rationale
Answer: B
StatPearls: "a single normal lumbar puncture does not exclude the diagnosis," "A negative tap test does not exclude iNPH," and "External lumbar drainage may be considered when tap test results remain equivocal and clinical suspicion persists" (B, A wrong). Acetazolamide has "a role only in nonsurgical candidates" (C). A normal pressure does not prove NPH (D).

Common questions

What causes hydrocephalus & normal pressure hydrocephalus?
Common causes and risk factors include brain or spinal cord tumors — posterior fossa tumors are commonly associated (ninds, statpearls), bleeding in the brain — subarachnoid hemorrhage accounts for one-third of communicating cases (statpearls); intraventricular hemorrhage, central nervous system infection — especially bacterial meningitis, head injury or stroke, older age (nph) — average onset around 70 years; inph accounts for an estimated 6% of dementia cases (statpearls), and others.
What are the early signs of hydrocephalus & normal pressure hydrocephalus?
Early findings include [HYD] Headache, nausea or vomiting, blurred or double vision, sleepiness, balance problems, [NPH] Gait disturbance — shuffling, wide-based, "magnetic" steps; trouble turning; freezing.
What is the difference between communicating and non-communicating hydrocephalus?
Non-communicating (obstructive) hydrocephalus comes from "a block in CSF pathways," often at the aqueduct or fourth ventricle. Communicating hydrocephalus "is caused by impaired absorption of CSF," most often after hemorrhage or inflammation such as meningitis (StatPearls).
Why is NPH called a reversible dementia?
StatPearls calls iNPH "a potentially reversible cause of dementia," but gait improves most reliably after a shunt; "Cognitive and urinary outcomes are more variable." Coexisting conditions such as Alzheimer disease can limit cognitive recovery.
How long does a shunt last?
NINDS: shunts "can stop working or lead to infection," and "A person may need multiple surgeries to repair or replace a shunt throughout their lifetime." Regular checkups and knowing the warning signs matter for life.
Why does an EVD have to be levelled so carefully?
The transducer must sit at the foramen of Monro — the level of the ear. If it is too high, the ICP reads falsely low and too little CSF drains; any mislevelling risks "erroneous ICP reading and/or over or under drainage," and overdrainage can cause rebleeding or herniation (EVD review; StatPearls).

Sources

Reviewed by Hae Suk Lee, RN

Educational summary for nursing students. Scenarios are fictional teaching cases. Always verify against current guidelines and your institution's protocols before acting in practice. Not medical advice.

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