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Normal pressure hydrocephalus: pathophysiology

Consultant Neurologist and Honorary Clinical Senior Lecturer, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; r.a.grunewald@sheffield.ac.uk

The first 150 words of the full text of this article appear below.

Jan Malm and Anders Eklund are to be congratulated on their review of idiopathic normal pressure hydrocephalus (NPH) ( Practical Neurology 2006;6:14–27[Free Full Text] ). The various theories of pathophysiology documented in their review are, however, unconvincing: how can mechanical compression of the brain parenchyma occur with normal sized ventricles and intracranial pressure? What is periventricular resorption of CSF and how does it cause reversible damage? What potentially toxic metabolites are present in CSF? What evidence is there for venous damage to the brain in this condition, and why should shunting reverse this? I should like to expound a simple, coherent explanation of the process based on information already in the public domain, largely summarised in Malm and Eklund’s review.

The brain is unusual in that it is the only organ surrounded by a rigid protective box, the skull, but this presents particular difficulties for its blood . . . [Full text of this article]