Q. Kindly explain whether MRI brain and CSF studies show any relation to NPH.

Answered by
Dr. Vivek Chail
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 24, 2018

Hello doctor,

Can you please give the diagnosis of the uploaded MRI brain and CSF studies with a detailed report? Please advise on the action plan as to how to get the CSF findings treated. The MRI report is enclosed. Does the enclosed report co-relate with your findings? The MRI report CSF studies report shows CSF hyperdynamic flow of absolute stroke volume of 110 microliters per second against the normal of 50 microliters per sec per cardiac cycle. Also, my treating neurologist wanted an opinion on the following. Are there signs of NPH? But do the findings of brain atrophy, ventriculomegaly, hyperdynamic CSF flows suggest of idiopathic hydrocephalus and are some intervention required?



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The findings in the report and the images are matching and acceptable (attachment removed to protect patient identity). The term NPH is usually applied in cases where there is abnormal CSF hyperdynamic circulation with gait problems or without gait problems if incontinence is there. Confirming NPH without typical features is difficult in your case. There are controversies regarding NPH and CSF hyperdynamic values and different researchers have come to variable conclusions. Since gait problems are most common in NPH, therefore, most researches have mentioned the importance of gait problems when confirming NPH or incontinence if gait problem is not there.

Treatment with shunting might help only when NPH is confirmed. If there is no NPH then the diagnosis is likely due to neurodegenerative disorders and the symptoms can be treated by medicines. There are many different and complicated types of neurodegenerative disorders and a clinical emphasis is more important than only MRI findings when confirming a condition.

Thank you doctor,

A couple of clarifications.

Are there CSF Flow circulations abnormalities as per the images? There are gait problems which is the most prominent feature in my case. Now there are also frequent falls and imbalance with head reeling. There are frequent episodes of urinary incontinence. The asymmetrical atrophy could be due to neurodegenerative disease. Are the CSF findings due to NPH or any other CSF flow disorders which may have to be further investigated? Please could you clarify on the above. It would be highly helpful for treatment by my neurologist.



Welcome back to

The CSF flow abnormalities are calculated by the MRI machine using available data and there is high accuracy in calculations and therefore the chances of error in the displayed values are less. It is important for you to follow up closely with your neurologist. If needed, then a second MRI with CSF flow might help to know the pattern of change in stroke volume with the progression of the condition.

I understand that your clinical symptoms and signs are closely resembling idiopathic NPH but it can get difficult to confirm a diagnosis based on a single scan report. Neurodegenerative disease can also cause overlapping symptoms. The treatment for idiopathic NPH is usually shunting but your diagnosis must be confirmed before treatment can be given. As a radiologist, my suggestion will be to review the scan after six months and this is to know if the flow of the CSF is following any reversal or any other changes. However please discuss in detail with your neurologist for a detailed evaluation of your symptoms and possible options for treatment.

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