Normal pressure hydrocephalus (NPH) is a neurological disorder where excess cerebrospinal fluid (CSF) accumulates in the brain.

NPH can cause thinking and reasoning problems, difficulty walking, and loss of bladder control.

People with multiple sclerosis (MS) also have a change in spinal fluid. In MS, the immune system attacks the myelin sheath, which is the protective layer around nerve fibers. Damage to the myelin sheath causes certain proteins to be released into the spinal fluid.

It’s estimated that nearly 700,000 adults have NPH, according to the Alzheimer’s Association, and the National Multiple Sclerosis Society reports that nearly 1 million people over age 18 years in the United States have multiple sclerosis.

Because CSF is an element of both conditions and symptoms like memory loss, unsteadiness moving, and urinary difficulties can present with both conditions, researchers have wondered for many years whether there’s a potential link between NPH and MS.

But as of now, no link between the two has been identified.

NPH occurs when excess CSF accumulates in your brain. Because your skull is a restrictive space filled with tissues and fluids, the arteries in your brain don’t have space to expand. Instead, the increased volume inside the arteries results in pressure being applied to the CSF.

This pressure causes the CSF to flow from your cranial subarachnoid space to the spinal subarachnoid space. Additionally, the pressure the arteries apply on the CSF causes pressure patterns on certain veins and pathways.

According to one 2016 study, at the same time that your arteries are applying pressure on the CSF, your CSF is applying pressure on the brain tissues. This results in a dampening of pulse pressure.

Although not exactly the same, the pulse pattern of CSF in people with MS is similar to those with NPH, according to the 2016 study. This pulse wave pattern plays a role in the symptoms experienced by those with NPH and may also be responsible for some of the symptoms those with MS experience.

However, the study had a limited number of participants, and those findings have not been replicated in any more studies. The findings should not be considered reliable.

Researchers who conducted the 2016 study believe that it’s possible there is a pulse pattern aspect to MS that’s being overlooked because of more obvious inflammatory aspects that present with MS. Currently, research has not yet clearly demonstrated whether the nerve deterioration is the root of MS or if the pulse waves play a role in initiating the condition.

At this time, the research between NPH and MS is not sufficient to prove if or how NPH is linked to MS. However, identifying a connection between the two is important because it may have an impact on diagnosis and treatment plans for people with MS.

It’s still unclear how or if NPH and MS are related. Hopefully with more research, medical professionals will gain a better understanding of whether there’s a connection.

While NPH and MS are separate disorders with different treatment options, they do share some similarities.

How they’re alike

From a symptom standpoint, both NPH and MS can result in:

How they’re different

The treatment plans for NPH and MS are different.

The only successful treatment for NPH is ventriculoperitoneal (ventricular) shunting. This is a surgical procedure where a shunt is placed in the brain to relieve the pressure that the fluid accumulating in that area causes.

However, surgery may not be appropriate for everyone with NPH. For example, those with severe dementia may be discouraged as the risks of surgery may outweigh the benefits.

On the other hand, MS is a chronic condition with no known cure. Treatment is focused on relieving symptoms to improve quality of life. Options include:

There’s still a lot to learn when it comes to a potential connection between hydrocephalus and MS. While there are some researchers who believe a link may exist, more information is needed at this point to conclusively prove any connection and how that should impact treatment.

Hydrocephalus and MS are diagnosed and treated differently and in unrelated manners.

If you are diagnosed with either condition, it’s important to speak with a medical professional about your care and possible treatments.