Normal Pressure Hydrocephalus (NPH): A Treatable Cause of Gait Problems and Memory Loss

April 24, 2026

Blogs, Geriatrics, Neurology, Neurosurgeon

Normal Pressure Hydrocephalus (NPH): A Treatable Cause of Gait Problems and Memory Loss

Verified By
KIMS-SUNSHINE
Specialist,
24 April, 2026

Normal Pressure Hydrocephalus NPH_ A Treatable Cause of Gait Problems and Memory Loss

The brain is a vital organ that is protected by not just the bony skull alone. It floats around in a cavity that contains cerebrospinal fluid (CSF) which is constantly being produced and drained from the skull. At times, too much of CSF can be made but it does not drain properly. This can lead to CSF building up and putting pressure against brain tissue. This can alter behaviour in certain ways- like memory loss, walking difficulty or gait imbalance, among other symptoms. If you notice these symptoms, then please call us for normal pressure hydrocephalus (NPH) treatment at KIMS Sunshine Hospital right away!

Causes for Normal Pressure Hydrocephalus-

Hydrocephalus can be primary or secondary in origin.

Primary or idiopathic NPH is a condition where there is no known cause for the excess CSF being made. Usually, a person makes about 400-600 ml of CSF per day, but most of it is recycled and drained, while only some is used by the brain.
Secondary NPH is when NPH is caused due to an underlying condition like a brain aneurysm, intracranial haemorrhage, tumors in the brain, infections like encephalitis or meningitis, traumatic brain injuries or stroke, among others, respectively.

Symptoms of NPH-

These are some commonly observed symptoms with this condition, though they are reversible in most cases, with treatment. Symptoms tend to develop over a few months and get worse. When these 3 major ones are observed, it is called the Hakim’s triad-

Gait imbalance is common, especially if you are older than 65 years of age.
Urinary incontinence is observed.
Cognitive difficulties- like memory loss.

You cannot lift your feet up, steps are shorter than before or you may freeze more often dur to uncertainty with movement. Your toes may face outward while you walk too, so you may walk with your feet wide apart, from one side to another.

You may urinate because you have poor bladder control and feel bad about it, or not- and that is probably why doctors think you have cognitive issues – when you stop feeling embarrassed.

With respect to cognitive issues- you may have memory loss, you may think or process information much slower than before, have executive dysfunction – where you are unable to make decisions, and have mood changes which seem more pronounced than before.

If you notice gait imbalance, memory loss and uncontrolled urination, please contact us at KIMS Sunshine Hospital, as we provide the best treatment for NPH in the city.

Diagnosis of Normal Pressure Hydrocephalus-

Physical symptoms are first taken into account, after which detailed imaging is recommended.

To get a hydrocephalus diagnosis, MRI scans are a common and often fool proof method used, while CT scans can be used to exclude all other conditions, and zero in on NPH as a possible cause. CT scans are not very helpful in directly diagnosing NPH though. MRIs provide clear images with information on soft tissue make up, presence of fluid build up, and different parts of the brain.
You may also be asked to get a lumbar puncture or spinal tap done to analyze CSF- this condition can help rule out other conditions and diagnose NPH if there is an infection like meningitis present. You may also feel much better after getting one done, as CSF levels drop, but this is temporary- symptoms will return as CSF levels increase. Hence, a spinal tap can be both diagnostic and treat the condition too, even if its effects don’t last for long.

Treatment of NPH-

An NPH shunt surgery can be used to treat primary NPH. Two tubes are used here- one where fluid fills up, the other from where fluid can drain and there is a valve between them, to ensure that once enough fluid has filled up, the valve tips open and CSF can drain away. The outflow or second catheter is placed in such a way that it drains into the chest. If it drains into the abdomen- it is called a ventriculoperitoneal shunt surgery.

Conclusion

Neurosurgery for hydrocephalus is the best treatment for NPH in the long term. For secondary NPH, the underlying condition is first treated, so that your symptoms get better. If you have any concerns, please call us at KIMS Sunshine Hospital today!

Frequently Asked Questions

Which specialist treats normal pressure hydrocephalus?

A neurosurgeon treats normal pressure hydrocephalus. Evaluation often involves a neurologist for cognitive and gait assessment, but treatment decisions and surgical management are led by a neurosurgeon.

What is a ventriculoperitoneal (VP) shunt procedure?

A ventriculoperitoneal shunt is a surgical treatment for hydrocephalus. It involves placing a thin tube from the brain’s ventricles to the abdominal cavity to drain excess cerebrospinal fluid. This relieves pressure on the brain and helps improve symptoms such as walking difficulty, memory problems and urinary issues.

How long does recovery take after shunt surgery?

Initial recovery after shunt surgery takes a few days in the hospital, with gradual improvement over weeks. Walking and balance may improve first, while memory and cognition can take longer. Follow-up visits are important to monitor shunt function and adjust settings if needed, ensuring optimal long-term outcomes.

When should I see a doctor for walking problems and memory loss?

See a doctor if you notice persistent difficulty walking, frequent falls, slowed movement, or memory decline that interferes with daily life. When these symptoms occur together with urinary urgency or incontinence, they may suggest conditions like normal pressure hydrocephalus and require timely neurological evaluation.

Where can I get expert neurosurgical care for hydrocephalus?

Expert care is available at hospitals with dedicated neurosurgery and neurology departments. We offer g brain imaging, shunt procedures and rehabilitation services, along with access to experienced neurosurgeons, neurologists and post-surgical care teams at KIMS Sunshine Hospital.