Further Experience with the Syndrome of “Normal” Pressure Hydrocephalus

Abstract

D URING the past 10 years, it has become possible to separate from the large number of adults with dementia a small group whose symptoms are related to normal pressure hydrocephalus. The typical early clinical picture is characterized by the gradual development over weeks to months of mild impairment of memory, physical and mental slowness, unsteadiness of gait, and urinary incontinence. With the patient lying on his side, the CSF pressure measured in the lumbar subarachnoid space is less than 180 mm of water. Pneumoencephalography (P EG) reveals marked ventricular enlargement and, in classic cases, a lack of filling of the subarachnoid space over the cerebral convexities. Following this procedure, there is often a marked increase in the symptoms and signs. Improvement follows a shunt operation. This report analyzes our surgical experience with a total of 28 cases, including five previously reported.l,2, 9