An audit of NPH referrals and practice in the Royal Victoria Infirmary in Newcastle

<h3></h3> Idiopathic Normal pressure hydrocephalus (iNPH) is a syndrome of enlarged ventricles with a triad of symptoms affecting gait, cognition, and urinary function (1). Diagnosis can be challenging as the symptoms overlap with other neurodegenerative disorders, where cerebral atrophy may also cause ventriculomegaly. The primary treatment is insertion of a CSF shunt (2), but due to the risks of this procedure correct diagnosis is crucial. This audit assessed how patients with suspected NPH are diagnosed and managed by the neuroscience department in the RVI, compared to the 2021 Japanese NPH guidelines (1). We performed a retrospective audit from Jan 2017 to Dec 2019, with 87 referrals identified. 59 patients (68%) were diagnosed with NPH clinically, and 52 (60%) were shunted. Using the 2021 guidelines only 32 (37%) met the criteria for probable NPH and only 24 (28%) were shunted in line with the guidelines. Of the 52 patients shunted 26 (50%) had improved at their last follow-up. Further analysis showed that 54% of those shunted in line with the guidelines had a good response, while only 46% of those shunted but not in line with the guidelines. This information was used to development a dedicated NPH MDT at the RVI.