Normal pressure hydrocephalus [Neurosurgery Wiki]

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====== Normal pressure hydrocephalus ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1N3QNDYjRmvsmEidUYSvNr6jDUg98Kfty-5NhHd-SO04BE1MQC/?limit=15&utm_campaign=pubmed-2&fc=20230602170342}}
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Although the [[prevalence]] of Normal-pressure [[hydrocephalus]] (NPH) remains imprecise and is calculated to be 1.30% for those aged ≥ 65 years, a severe problem of underdiagnosis seems to exist
((Martín-Láez R, Caballero-Arzapalo H, López-Menéndez LÁ,
Arango-Lasprilla JC, Vázquez-Barquero A (2015) Epidemiology
of idiopathic normal pressure hydrocephalus: a systematic review
of the literature. World Neurosurgery 84:2002–2009. https://doi.
org/10.1016/j.wneu.2015.07.005)).

===== Classification =====

[[Normal-pressure hydrocephalus classification]].

===== Pathophysiology =====
[[Normal pressure hydrocephalus pathophysiology]].

===== Diagnosis =====

see [[Idiopathic Normal pressure hydrocephalus diagnosis]].

Its clinical diagnosis and pathological mechanism are still unclear. [[Leucine-rich alpha-2 glycoprotein ]] (LRG) is involved in various human diseases, including cancer, diabetes, cardiovascular disease, and nervous system diseases. Now the physiological mechanism of LRG is still being explored. According to the current research results on LRG, ma et al. found that the agency of LRG has much to do with the known pathological process of NPH. According to the collected literature evidence, they speculated that LRG probably be involved in the pathological process of NPH. Finally, based on the mechanism of LRG and NPH, thy also summarized the evidence of molecular targeted therapies for future research and clinical application
((Ma L, Wang W, Zhao Y, Liu M, Ye W, Li X. Application of LRG mechanism in normal pressure hydrocephalus. Heliyon. 2023 Dec 16;10(1):e23940. doi: 10.1016/j.heliyon.2023.e23940. PMID: 38223707; PMCID: PMC10784321.)).
===== Differential diagnosis =====

[[Normal Pressure Hydrocephalus Differential Diagnosis]].

===== Treatment =====

see [[Idiopathic normal pressure hydrocephalus treatment]].

===== Case series =====

see [[Idiopathic normal pressure hydrocephalus case series]].

===== Case reports =====
A case of normal pressure hydrocephalus (NPH) 2 months after acute [[COVID]]19 infection, in a patient without other risk factors.

A 45-year-old male patient presented an 8-month history of progressive [[gait disorder]] and [[cognitive impairment]] after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal [[tap test]] was positive and there was progressive improvement after shunting, with complete resolution of symptoms.

Other infections such as [[syphilis]], [[cryptococcosis]] and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of [[choroid plexus]] cells by direct viral invasion or as a result of [[neuroinflammation]] and [[cytokine]] release and [[hypercoagulability]] leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible [[dementia]], it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association
((Vasconcelos TMF, Nóbrega PR, Ferreira GM, de Souza MLP, Vanderlei AS, de Castro JDV, Braga-Neto P, Sobreira-Neto MA. Normal pressure hydrocephalus associated with COVID-19 infection: a case report. BMC Infect Dis. 2022 Mar 3;22(1):216. doi: 10.1186/s12879-022-07184-x. PMID: 35241017; PMCID: PMC8892823.))