Normal pressure hydrocephalus

BACKGROUND-Doctors find the diagnosis and treatment of normal pressure hydrocephalus difficult because their diagnosis is often inaccurate, and the treatment with shunt surgery carries a significant risk.REVIEW SUMMARY-With the aim of bringing to the attention of physicians the useful, but largely anecdotal information available regarding this problem, this review will address the following: the reasons why the diagnosis is difficult; the differential diagnosis; and items that may help the clinician with the diagnosis in the history, examination, neuropsy-chological assessment, radiological evaluation, and special tests. The review will also address how to measure surgical outcome, surgical complications, and choice of shunt. Lastly, it will discuss associations with idiopathic normal pressure hydrocephalus that might have implications related to etiology.CONCLUSION-This review presents a practical approach to the management of these patients given the present state of knowledge.