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November 10, 1989

Normal-pressure Hydrocephalus: Saga or Swamp?

JAMA. 1989;262(18):2592-2593. doi:10.1001/jama.1989.03430180134044

Normal-pressure hydrocephalus (NPH) was first identified by Adams et al1 in 1965. They described three patients: two women aged 62 and 63 years and one man aged 65 years who presented with the triad of dementia of recent onset, gait disorder, and urinary incontinence. Cerebrospinal fluid shunting provided a spectacular cure in all three cases.

Since that time, many case series have been published (for example, references 2 through 5) and reviewed.6,7 The syndrome is one of communicating hydrocephalus in which intracranial hypertension is either absent or goes unrecognized. Although it can occur secondary to head injury, subarachnoid hemorrhage, intracranial surgery, brain tumors, or meningitis, most patients give no such history and the syndrome is consequently termed "idiopathic."6

In this issue of The Journal, Friedland8 provides us with a case history that involves a successful shunt procedure for an elderly woman with NPH. What makes this