Normal Pressure Hydrocephalus: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Normal Pressure Hydrocephalus?
A neurologist (a doctor who treats brain and nerve problems) or a neurosurgeon (a surgeon who operates on the brain and nerves) usually cares for normal pressure hydrocephalus. The most common treatment is a shunt, a thin tube that drains extra fluid from the brain. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is normal pressure hydrocephalus?
Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) deep within the brain. The extra fluid widens the ventricles, which are cavities inside the brain.
Normal pressure hydrocephalus (NPH) is one type of hydrocephalus. It causes problems with walking, bladder control, and thinking and reasoning. The fluid builds up slowly, so the tissues around the ventricles adjust and the fluid pressure inside the head does not rise.
NPH can happen at any age, but it is most common in older adults. Symptoms usually get worse over time if NPH is not treated. NPH can be hard to diagnose, and many people do not get proper treatment. Other conditions, such as Alzheimer’s disease, can look like NPH.
Symptoms
Doctors look for three main signs in NPH:
- Trouble walking. Steps are often slow and short, and they shuffle, with the feet set wide apart.
- Loss of bladder control. It almost always includes a sudden, strong need to urinate.
- Trouble with thinking. A person may have poor attention, be slow to recall things, and lack the drive to start things.
Walking problems are most often the first and biggest problem. People may also have trouble starting to walk, poor balance, and frequent falls. Bladder problems usually start after the walking problems.
Causes and who gets it
In NPH, the body does not absorb CSF as well as it should. NPH can follow bleeding in the brain’s CSF spaces, a head injury, an infection, a tumor, or a complication of surgery. However, many people develop NPH when none of these factors are present.
How doctors diagnose it
A doctor starts with a neurological exam and brain imaging. MRI (magnetic resonance imaging) and CT (computed tomography) are brain scans that can show whether the ventricles are enlarged. In NPH, the scans typically show enlarged ventricles with the surrounding brain tissue preserved. In Alzheimer’s disease, the scans show enlarged ventricles with much loss of brain tissue. Scans also help show that bleeding around the brain, an infection, or a tumor is not the cause.
A spinal tap, also called a lumbar puncture, uses a needle in the lower back to remove and test some of the fluid. In NPH, doctors may remove a larger amount of fluid and see whether symptoms get better. People whose symptoms improve after this have a greater chance of responding to a shunt. No single test proves that someone has NPH.
Treatment
The most common treatment is surgery to place a shunt. A shunt is a tube that drains extra fluid so the body can absorb it. In NPH, the usual shunt runs from the brain to the belly. The surgery is done under general anesthesia, which means the person is asleep.
Shunts do not help everyone, and results vary widely from person to person. People with a known cause of NPH are more likely to improve than people without one. Symptoms that have lasted a shorter time are also more likely to improve. Memory and thinking problems are often the last to improve after a shunt.
The most serious risks of shunt surgery include bleeding in or around the brain. A shunt can also stop working or lead to infection. Some people need more than one surgery to repair or replace a shunt over their lifetime.
When to see a doctor
A doctor should check walking trouble, bladder control problems, and thinking changes, even if only some of them are present. Early diagnosis and treatment improve the chance of a good recovery. Without treatment, NPH symptoms may worsen and cause death.
If you have a shunt, get medical help right away if you have signs that it may not be working. These signs include headache, nausea or vomiting, double vision, or sore neck or shoulder muscles. Redness or tenderness along the shunt, a low-grade fever, or the return of your hydrocephalus symptoms are also warning signs.
Call 911 or go to the emergency room if you faint or lose consciousness. Do the same for a sudden change in mental state, such as confusion or trouble waking up.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A primary care doctor can notice the pattern of walking, bladder, and thinking changes and refer you to a neurologist or neurosurgeon. They can also help with follow-up care.
Common questions
Is normal pressure hydrocephalus a type of dementia?
Not exactly, but NPH can cause memory and thinking problems, so doctors sometimes call it a treatable form of dementia. It is a different problem from Alzheimer’s disease, and brain scans can help tell them apart.
Can normal pressure hydrocephalus be treated?
Yes, it is often treatable. The most common treatment is a shunt, which drains extra fluid. How much it helps varies from person to person.
What is usually the first sign of normal pressure hydrocephalus?
Trouble walking is usually the first sign. Bladder control problems usually follow, and thinking problems are usually not the first sign.
Sources
- National Institute of Neurological Disorders and Stroke - Hydrocephalus
- American Academy of Family Physicians - Management of Normal Pressure Hydrocephalus
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
