Classical symptoms of Normal Pressure Hydrocephalus.
Symptomatic Screen
Identify the presence of 'Wet, Wacky, and Wobbly' clinical markers to evaluate for potentially reversible Normal Pressure Hydrocephalus.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Evaluating elderly patients presenting with cognitive decline or falls.
Differentiating iNPH from Alzheimer's Disease, Parkinson's Disease, or general vascular dementia.
Section 2
Formula & Logic
Ventricular Enlargement
In iNPH, despite normal CSF pressure on lumbar puncture, transient high-pressure waves cause ventricular enlargement. This expansion selectively stretches the descending sacral motor fibers (corona radiata) that run closest to the ventricles—explaining why leg function (gait) and sphincter control (incontinence) are affected early, while arm movements are spared.
Section 3
Pearls/Pitfalls
Predicting Shunt Success
The full triad is present in less than half of patients at time of diagnosis. Gait disturbance is typically the first symptom to appear, and is the MOST LIKELY symptom to improve after a VP shunt. If dementia precedes gait disturbance, the patient likely has Alzheimer's disease, and shunting is less likely to be beneficial.
Section 4
Evidence Appraisal
Primary Reference
The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics
