Normal Pressure Hydrocephalus 

What is Normal Pressure Hydrocephalus (NPH)?

Normal Pressure Hydrocephalus (NPH) is a condition caused by an abnormal buildup of cerebrospinal fluid (CSF) in the brain’s ventricles. CSF normally cushions the brain and spinal cord and is produced and absorbed in balance each day. When this balance is disrupted and too much fluid accumulates, it can lead to NPH. 

Common Symptoms of NPH 

NPH often develops gradually and can be mistaken for other conditions, such as normal aging or dementia. We ask patients if they are experiencing any of the following: 

• Difficulty walking or climbing stairs 
• A sensation of the feet “sticking to the floor” while walking 
• Impaired bladder control or incontinence 
• Frequent urination
• Increased forgetfulness or memory loss 
• Difficulty managing daily tasks or reduced executive function 
• Noticeable mood changes 

Our Clinic’s Approach 

At our NPH Clinic, we offer comprehensive evaluation and diagnosis. The process typically includes: 

• An initial walking assessment 
• A lumbar puncture (spinal tap) to remove a small amount of CSF 
• A repeat walking assessment to evaluate changes 
• This diagnostic approach helps us determine whether a patient may benefit from further treatment, such as shunt placement, which can significantly improve symptoms. 

Criteria for NPH Clinic  

Patients must be referred by a neurologist or by a neurosurgeon. 

For patients preparing for your appointment: You must complete a questionnaire prior to your appointment. This will help us expedite your appointment and determine if you are a candidate for the in-office, lumbar puncture procedure. The questionnaire must be completed and returned to the neurosurgery clinic prior to confirming an appointment date. You must complete a blood test to check your platelets prior to your appointment. You may complete the blood test locally at a Quest or LabCorp or here at UCSF on the morning of your appointment.

Referral Information

To be evaluated at the Normal Pressure Hydrocephalus (NPH) Clinic, a referral from a healthcare provider is required.

Referring providers should submit the following documentation: 

• A recent brain imaging report (MRI or CT scan preferred) 
• A copy of the patient’s demographic information (including date of birth, address, and contact details) 
• Insurance information 
• A clinical note from the referring provider documenting the patient's symptoms, including mobility changes, urinary issues, and/or cognitive concerns 

Where to Send Referrals: 

Fax: (415) 353-2889 

If you have questions about the referral process, please contact: 
Phone: (415) 353-7500 

For Patients: 

Please talk to your primary care provider or neurologist about sending a referral to our clinic. Once the referral and documentation are received, our team will review the information and contact you to schedule an appointment.