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Updated: Oct 18, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Normal pressure hydrocephalus in people with multiple sclerosis
Purnashree Chowdhury1, Jeremy K Cutsforth-Gregory2, David T Jones2
1Department of Neurology, Mayo Clinic, Rochester, MN, USA; Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
Background:
Aging people with multiple sclerosis (pwMS) may develop idiopathic normal pressure hydrocephalus (INPH).
Objectives:
Describe clinical, investigational, and treatment courses in pwMS and INPH.
Methods:
Retrospective Mayo Clinic database review of "MS" and "NPH" and "Gait disorder" 1996-2025.
Inclusion Criteria:
1) pwMS; 2) INPH; 3) INPH gait impairment (gait apraxia and/or ataxia).
Exclusion Criteria:
non-INPH gait impairment or absent neurologist examination. Demographics, clinical course, INPH triad features (gait disorder, cognitive dysfunction, bladder dysfunction) were recorded. INPH was defined as possible (≥2 INPH triad and ventriculomegaly), probable (possible INPH with Disproportionately Enlarged Sub-arachnoid space Hydrocephalus [DESH] or positive high-volume tap test [HVTT]) and definite (gait improvement following ventriculoperitoneal [VP] shunt). Cerebrospinal fluid studies, brain magnetic resonance imaging findings and gait outcome following HVTT and VP shunt were recorded.
Results:
Thirty-six pwMS and INPH were included. Twenty-six (72%) female, 35 (97%) white ethnicity, age (median, interquartile range [IQR]) at MS onset 49.0 (32.5-59.0) years, and at INPH onset 67.5 (60.8-70.3) years. Nineteen (53%) had secondary progressive MS; 10 (28%), relapsing-remitting and 7 (19%), primary progressive MS. INPH was definite in 10 (28%), probable in 9 (25%) and possible in 17 (47%). All had INPH gait disorder, 30 (83%) bladder dysfunction, 24 (67%) cognitive dysfunction and 20 (56%) with full INPH triad. DESH was present in 23/36 (64%). HVTT performed in 24/36 (67%), with gait improvement in 14 (58%). Twelve (33%) underwent VP shunt, with gait improvement in 10 (83%).
Conclusion:
PwMS and INPH may have a surgically amenable gait disorder.
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Increased Intracranial Pressure l: Introduction
Increased Intracranial Pressure ll: Pathophysiology
Multiple Sclerosis l: Introduction
Cerebral Edema ll: Pathophysiology
Cerebral Edema l: Introduction
Cerebrospinal Fluid
CSF Production
CSF is produced mainly in the choroid plexus, a network of capillaries and ependymal cells located within the ventricular system of the brain.
