Normal Pressure Hydrocephalus Program

The UCSF Normal Pressure hydrocephalus program evaluates and treats adult patients with a specific form of hydrocephalus called normal pressure hydrocephalus. This is a clinical diagnosis based on a combination of clinical symptoms, which include gait disturbance, urinary incontinence, and some problems with higher cortical function. This may be associated with enlargement of the ventricles, which are the fluid spaces within the brain. Enlargement of the ventricles can be seen on CT scans or MRI scans.

Our multidisciplinary team is trained to assist with confirming the diagnosis through clinical evaluation, neurological examination, provocative testing, and review of imaging studies. Patients who fulfill the criteria for this diagnosis may be considered for surgical treatment.

The Normal Pressure Hydrocephalus Team


The Normal Pressure Hydrocephalus Program is led by neurologists Gary Abrams M.D. and Karunesh Ganguly M.D., Ph.D., who collaborate with neurosurgeons and neuroradiologists to identify the best treatment option for each patient. Patients are evaluated first in the Normal Pressure Hydrocephalus Clinic in the Department of Neurology. A review of medical records, repeat clinical examination, gait assessment, and review of imaging studies is performed.

Through standardized evaluations of this information, patients may be recommended (or not) to provocative testing with outpatient large volume spinal taps. During this testing, cerebral spinal fluid is withdrawn to determine the clinical response to this intervention based on improvements in walking and bladder control. If the response to large volume spinal tap is uncertain, a patient may be a candidate for one-day admission for insertion of a lumbar subarachnoid drain for extended cerebral spinal fluid withdrawal. The same gait evaluations and clinical reports from the patient and family about improvements after this intervention will help our physicians determine whether patients would be good candidates for surgical treatment.

Types of Hydrocephlaus We Treat


In the Normal Pressure Hydrocephalus Program our focus is on older adults who have a clinical syndrome, which includes gait imbalance, urinary incontinence and some cognitive decline. There are other types of hydrocephalus that may be managed by other practitioners in adult neurology and neurosurgery. Obstructive and communicating hydrocephalus are two types of hydrocephalus that may result from other clinical conditions and are usually associated with symptoms of elevated intracranial pressure such as headaches, visual disturbance, nausea, and vomiting. These types of hydrocephalus are associated with elevated intracranial pressure rather than normal pressures.

There are a variety of causes for early childhood or congenital hydrocephalus that may be seen shortly after birth through early childhood and adolescence. These may be associated with other conditions such as spina bifida and are managed by our pediatric neurologists and pediatric neurosurgeons.

The goal of the Normal Pressure Hydrocephalus program is to ensure that patients receive an accurate diagnosis by an expert neurologist before referral to a neurosurgeon for surgical treatment. Patients who are recommended to shunting procedures can discuss the different types of shunts that would be recommended depending on their situation with their neurosurgeon. While a majority of patients who respond to the large volume spinal taps or extended lumbar drainage would be expected to have clinical improvement following a surgical procedure with the implantation of a device allowing permanent cerebral spinal fluid drainage, the benefits may slowly wane over time due to other conditions associated with aging.