Which physical findings indicate normal pressure hydrocephalus (NPH)?

Updated: Jun 04, 2018
  • Author: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Patients with NPH may exhibit the following findings on examination:

  • Normal muscle strength; no sensory loss

  • Increased reflexes and Babinski response in one or both feet: Search for vascular risk factors (causing associated brain microangiopathy or vascular Parkinsonism), which are common in NPH patients

  • Variable difficulty in walking: May have mild imbalance to inability to walk or to stand; the classic gait impairment consists of short steps, wide base, externally rotated feet, and lack of festination (hastening of cadence with progressively shortening stride length, a hallmark of the gait impairment of Parkinson disease)

  • Frontal release signs (in late stages): Appearance of sucking and grasping reflexes

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