Gait disorder is the cardinal sign of normal pressure hydrocephalus: a case study

J Neurosci Nurs. 2007 Jun;39(3):132-4, 192. doi: 10.1097/01376517-200706000-00002.


Normal pressure hydrocephalus (NPH) is one of the few reversible causes of dementia in older adults and accounts for approximately 6% of all dementias. The cardinal sign of NPH is a hypokinetic gait disorder in which the older adult's feet look as though they are glued to the floor. The gait also has been described as magnetic. People with NPH also may have mild dementia and bladder and bowel incontinence. A 78-year-old man exhibited symptoms of NPH for at least 4 years before being diagnosed. A neurological assessment of the patient revealed gait, posture, and balance abnormalities; mild dementia; and urinary urgency, frequency, nocturia, and incontinence at least once a day. His risk factors for NPH included diabetes and hypertension. A computed tomography (CT) scan revealed dilated lateral ventricles in the brain. A lumbar puncture was used to remove 50 ml of cerebrospinal fluid, which resulted in a transient improvement in his gait for approximately 18 hours. A ventriculoperitoneal shunt was then inserted in the patient, and during a 1-year period his symptoms gradually improved. He recovered without any complications and was eventually able to resume his usual activities. When the gait associated with NPH is observed in an older adult, he or she should be referred to a neurologist or multidisciplinary team for a comprehensive evaluation. If an individual receives treatment for NPH, he or she may have an improved quality of life and the opportunity to reduce functional limitations and disability. Families may also experience positive outcomes, such as having a loved one who is cognitively improved and requires less care.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Activities of Daily Living
  • Aged
  • Dementia / complications
  • Diabetes Mellitus, Type 2 / complications
  • Diagnostic Errors
  • Gait Disorders, Neurologic / diagnosis*
  • Gait Disorders, Neurologic / etiology*
  • Geriatric Assessment
  • Humans
  • Hydrocephalus, Normal Pressure / complications*
  • Hydrocephalus, Normal Pressure / diagnosis*
  • Hydrocephalus, Normal Pressure / surgery
  • Hypertension / complications
  • Male
  • Neurologic Examination / methods
  • Neurologic Examination / nursing
  • Nurse's Role
  • Nursing Assessment / methods
  • Quality of Life
  • Referral and Consultation
  • Risk Factors
  • Spinal Puncture
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Urinary Incontinence / etiology
  • Ventriculoperitoneal Shunt / nursing