Unit 1: Normal Pressure Hydrocephalus (NPH)

Question 1

What are the Neurological S/S Triad for Normal Pressure Hydrocephalus (NPH)?

Answer 1

• Gait disturbance
• Cognitive Impairment
• Urinary Incontinence

Question 2

Normal Pressure Hydrocephalus (NPH)

Answer 2

impairment of CSF absorption

• CSF accumulates in the ventricles of the brain b/c of decreased CSF reabsorption by the arachnoid villi
• present with normal ICP
• causes physical and mental changes that lead to patient suffering and decreased quality of life
• can cause premature death

Question 3

What causes NPH?

Answer 3

• idiopathic or

- secondary to a underlying cause (head trauma, subarachnoid hemorrhage, brain tumor, or infection (meningitis))

Question 4

How do the signs and symptoms arise?

Answer 4

• the enlarged ventricles can cause vascular and periventricular damage due to increasing edema; symptoms arise as the brain tissue is compressed from CSF accumulation and increasing edema
• S/S progress over months or years, but can occur suddenly if experience acute head injury or trauma
• S/S are reversible if NPH is diagnosed and treated early

Question 5

Gait Disturbance

Answer 5

most prominent clinical feature

• first to appear
• develops a shuffling gait and take wide-based steps; increased risk for falls
• are progressive; if not treated will slowly lose ability to walk
• can experience dizziness, causing a loss of balance when changing position or turning
• listen for complaints of “heavy feet” or feeling as though the feet are “glued to the floor” (shuffling)

Question 6

Cognitive Impairment

Answer 6

subtle or severe change in mentation

• trouble remaining attentive and recalling information
• slow to respond during conversation
• treatment with VP shunting may lead to full restoration of cognition

Question 7

Urinary Incontinence

Answer 7

difficulty with frequency and urgency

• in early stages, may experience urgency rather than incontinence
• gait impairment may prevent them from getting to the bathroom in time, leading to incontinence

Question 8

Diagnostic Testing

Answer 8

no gold standard

• CT
• MRI
• lumbar puncture
• ICP monitoring
• External Lumbar Drainage

Question 9

CT and MRI

Answer 9

used to determine ventricle size and identify possible hydrocephalus

Question 10

Lumbar Tap Test via Lumbar Puncture and External Lumbar Drainage

Answer 10

in a hospital setting for up to a week to monitor for improvement in signs and symptoms

Question 11

ICP Monitoring

Answer 11

may reveal intermittent rhythmic pressure deviations

Question 12

Standard Treatment for Normal Pressure Hydrocephalus (NPH)

Answer 12

surgical placement of a VP shunt

Question 13

Goal of Shunt Surgery

Answer 13

maintain adequate drainage of CSF in order to improve the patients preoperative signs and symptoms and quality of life

Question 14

Who have a higher risk for surgical complications and poorer outcomes?

Answer 14

patients who have multiple comorbidities, those r/t cardiovascular and cerebrovascular disorders

Question 15

Externalized Ventriculostomy Drain (EVD)

Answer 15

may be placed before a patient undergoes surgery to assess the benefits of placing a permanent VP shunt
-if patient has a positive response to CSF drainage, either through lumbar tap test or EVD, patient is then considered appropriate candidate

Question 16

Complications of a VP shunt

Answer 16

• infection of shunt catheter
• intracerebral hematoma
• seizures
• shunt malfunction (misplacement or kinking)

Question 17

Post-op nursing responsibilities (after shunt placement)

Answer 17

• Assess for clinical improvement as well as complications (cognition improvement most apparent change after shunt placement, then reversal of incontinence, then stability of gait)
• Perform frequent neuro assessments (to assess for complications)
• Monitor for signs of infection at incision site and perform daily dressing changes
• Know when to notify neurosurgeon (if S/S experienced preoperatively begin to reappear this could be a sign that the shunt is malfunctioning)
• Report sustained or postural headaches

Question 18

What happens if NPH is left untreated?

Answer 18

begin to lose vital functions (ability to think clearly, walk independently, and maintain control of bodily functions)
-S/S are dramatically reversed with VP shunting