Evaluation for NPH

Before your examination with us, we require an MRI scan of your brain (alternatively a CT scan if an MRI cannot be performed).

If you have not yet had a brain scan, it can be carried out on site, but it is not included in the evaluation package.

You will first be assessed by our neurologist and neurosurgeon to determine whether your symptoms are consistent with NPH or whether there may be other explanations for your symptoms. If we find that your condition is compatible with NPH, we can offer surgical treatment.

We will often need to perform a gait test and a measurement of the pressure in your brain, supplemented by a tap test. These examinations are carried out on the same day. You will be asked to walk along a corridor while we record a video of your gait. After that, our neurologist or neurosurgeon will perform a pressure measurement. During the pressure measurement, we may need to take samples of your cerebrospinal fluid, known as a tap test.

If you have symptoms of normal pressure hydrocephalus (NPH), you should be evaluated so that treatment can be initiated.

Before the treatment, you will receive an appointment letter about any medication related to your examination.

We recommend that you bring a relative or companion to your evaluation.

The evaluation may vary in extent depending on your symptoms and can take up to 2.5 hours.

Before the examination, we require an MRI scan of your brain. If an MRI scan cannot be performed, a CT scan can be used instead. Most patients have already had a scan before being referred for evaluation for NPH.

Initially, you will be examined by our neurologist and neurosurgeon together to determine whether your symptoms are consistent with NPH or whether there may be other explanations for your symptoms.

If we assess that the condition is consistent with NPH, we can offer treatment with surgery and placement of a ventriculoperitoneal shunt. Often the diagnosis is not straightforward, and we may need to perform a measurement of the pressure in your brain, supplemented by a so-called tap test. This examination is performed on the same day.

MMSE (Mini Mental State Examination)

In some cases, we will perform an MMSE to assess your cognitive status.

Measurement of brain pressure (lumbar tap test with opening pressure measurement)

First, you will undergo a gait test, where you are asked to walk in the corridor while we record a video of your walking.

Afterwards, one of our neurologists or the neurosurgeon will perform a pressure measurement. During the procedure, you will receive local anaesthesia and lie on your side in a bed with a duvet or blanket.

We ask you to curl your back, and the measurement is performed by inserting a needle between two lumbar vertebrae into the spinal canal. The local anaesthetic does not fully numb the area near the bone, and you may feel if the needle touches a bone. If the needle touches a nerve, you may experience temporary pain radiating down the leg. It is important that you inform us about what you feel. Samples of cerebrospinal fluid may be taken before the needle is connected to the measuring equipment. The doctor will inform you throughout the procedure.

Tap test

During the tap test, we drain 40–50 ml of cerebrospinal fluid before removing the needle. After the test, you will lie down for approximately 20 minutes. When the time has passed, you will repeat the gait test, which will be recorded on video.

We will contact you one week after the examination. At this point, the doctors will assess whether the tap test is positive, and we may offer a VP shunt operation. Otherwise, you will likely be discharged from Privathospitalet Mølholm.

If we assess that it is NPH, we offer surgery with a VP shunt. Together, we will schedule a time for the operation. Privathospitalet Mølholm offers a complete evaluation and surgery without waiting time, as part of a combined treatment pathway lasting two to three days. The surgery itself takes approximately 45 minutes.