Background: Normal pressure hydrocephalus (NPH) is a critical brain disorder in which
excess Cerebrospinal Fluid (CSF) is accumulated in the brain’s ventricles causing damage or disruption
of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech,
impaired decision making and critical thinking, and loss of bladder and bowl control are considered
the hallmark features of NPH.
Objective: The current review was aimed to present a comprehensive overview and critical appraisal
of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the
effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent
developments and utilization of pharmacological agents for the treatment of hydrocephalus has
also been appraised.
Results: Considering the complications associated with the shunt-based surgical operations, consistent
monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having
extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated
with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI,
coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging
(DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several
adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have
earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological
agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids,
NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of
secondary sensory/intellectual complications.
Conclusion: Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis
and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid
(CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage,
and protection of brain from further deterioration.