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NPH Referring Physician Resources

The Henry Ford Health Multidisciplinary Normal Pressure Hydrocephalus (NPH) Program provides coordinated care across specialties for optimal evaluation and treatment. Our expertise draws patient referrals from across the region.

More information about normal pressure hydrocephalus

There should be a degree of suspicion in older adults presenting with enlarged brain ventricles and primary symptoms of gait disorder, urinary urgency, or incontinence and cognitive decline.

However, these indicators are not always synonymous with normal pressure hydrocephalus. A relatively small number of patients end up having NPH:

  • Approximately 6 percent of individuals with large ventricles are diagnosed with NPH.
  • Only about 18 percent of those with large ventricles and a gait disorder have NPH.

Surgery is the only treatment for NPH. Shunting is most common. Endoscopic third ventriculostomy (ETV) may be beneficial for some patients. Gait is likely to improve with these procedures. Memory and urinary incontinence are unlikely to improve.

About the Henry Ford Multidisciplinary NPH Program

We are among the few programs in the region using a multidisciplinary approach to evaluate and treat normal pressure hydrocephalus. The team includes neurosurgeons, behavioral neurologists, neuropsychologists, urologists and nurse coordinators. We offer the highest level of care and maintain exceptional outcomes.

To learn more about our evidence-based approach, view NPH Pearls.

Make a referral to the Henry Ford Multidisciplinary NPH Program

We welcome referrals from providers who are concerned about older adults with enlarged ventricles and NPH symptoms. Our team looks forward to collaborating with you on your patient’s care.

To make a referral:

Complete our NPH referral form.

Supplemental information we need includes:

  • Patient insurance: Send a copy of the front and back of the patient’s insurance card.
  • Lab work: Order and provide results of the following tests:
    • Complete blood count (CBC)
    • Comprehensive metabolic profile, including magnesium, phosphorus, thyroid stimulating hormone, vitamin B12, ionized calcium, hemoglobin A1C, homocysteine, methylmalonic acid and vitamin D
  • MRI: Please obtain and send the results of:
    • Brain MRI without contrast
    • Cervical spine MRI without contrast
  • Alternative imaging: If the patient is unable to have an MRI (due to shrapnel, pacemaker, etc.), please obtain a CT and CT c-spine.

Submit this information to the NPH Clinic Nurse Coordinator:

Important note before making an NPH referral

Please consider whether medications may be causing the patient’s symptoms. For a list of drugs that contribute to problems with gait, cognition and urinary incontinence/urgency, view the Modified Beers List (Appendix A).

NPH referral review process

After we receive your complete submission, here’s what happens:

  • Nurse coordinator reviews the case within three business days.
  • We contact the patient or their caregiver to request additional information, including medical records.
  • Patient’s case is presented at our NPH multidisciplinary conference, which is every Wednesday at 1 p.m.
  • Nurse coordinator follows up with referring provider to share findings. Eligible patients will be contacted to set up a comprehensive NPH evaluation.

Multidisciplinary NPH evaluation and treatment

NPH evaluations take up to three hours and include:

  • Neurological exam
  • Cognitive testing from a neuropsychologist
  • Ambulatory/gait evaluation

The multidisciplinary team reviews results at the next case conference and proceeds with treatment if warranted.

Referring providers receive copies of multidisciplinary team notes regarding case discussion, evaluation findings and final recommendations. We provide pre-operative, post-operative and shunt programming care for the patient. The team also performs annual NPH clinic evaluations.

The Henry Ford NPH multidisciplinary team

Contact us

Please contact us if you have questions about our program or the patient referral process:

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