IJCNMH ARCpublishing

Issue: Issue 3 (2016) – Supplement 1


Is NPH over-diagnosed?

Michael Geschwind
Point of view: Yes
Normal pressure hydrocephalus is characterized by the classic triad of cognitive dysfunction, gait disorder and urinary incontinence, sometimes colloquially referred to as the 3 Ws “woozy, wobbly and watery.” A well-published New York Times article claimed that a vast percentage of Alzheimer’s disease cases did not in fact have AD, but rather had NPH, which was treatable. This lay article among other lay literature has suggested that NPH is an underdiagnosed condition. As my university, the University of California San Francisco (UCSF) is a major neurology and neurosurgery tertiary referral center we have been referred many cases of suspected NPH, often for shunting, in whom we have determined patients do not have an NPH disorder. Part of the problem lies with NPH being a poorly defined entity both clinically and radiologically. Although the entity of NPH exists and some of the symptoms can be treatable and even reversible, it is imperative to avoid placing a shunt in a patient with a neurodegenerative disease that will result in progressive atrophy leading to shunt complications such as subdural hematomas.

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):D38
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