Normal pressure hydrocephalus vs Benign intracranial hypertension

These two sometimes get confused

NPH tends to happen in older patients and can be confused for Alzheimers or Parkinsonism. There is an accumulation of CSF in the ventricles (which are enlarged) and this happens slowly. Because it is slow - there are no dramatic effects of raised intracranial pressure. The patients instead get a classical triad of Wet, Wobbly & Whacky

• Urinary incontinence
• Ataxia
• Dementia

The dementia has severe memory loss. Though recognition is less impaired - and it is this feature which helps to differentiate it clinically from Alzheimers.The ventricles are enlarged. It can follow a history of head injury

They can do rather well in terms of symptoms following a shunt insertion

Benign intracranial hypertension is where the patient has the symptoms of raised intracranial pressure, but without the inconvenience of an underlying tumour.

They tend to be young fat women. They get:

• Headache (worse on coughing and bending forward).... which you wanna do when you are....
• Nausea & vomiting
• Papilloedema
• Sixth cranial nerve palsy (abducens)
• Normal MRI appearance