Normal pressure hydrocephalus (NPH): ischaemia, CSF stagnation or both

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Abstract
Normal pressure hydrocephalus (NPH) is a clinical and radiographic syndrome first described by Hakim and Adams in 1965 (Hakim and Adams, 1965) and characterized clinically by gait apraxia (‘magnetic gait’), incontinence and dementia, and diagnosed predominantly among people over the age of 60 years. Only a minority of patients present with the complete triad of symptoms, gait apraxia being the most common presenting complaint. On brain imaging, one sees ventricular enlargement without significant cerebral atrophy. The radiographic observation that best distinguishes the ventriculo‐megaly of NPH from the ‘hydrocephalus ex vacuo’ of advanced Alzheimer’s disease is the degree of dilatation of the peri‐hippocampal fissures (PHFs). PHFs are normal or only minimally dilated in NPH, and typically markedly dilated in Alzheimer’s disease.

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