NPH and CSF Disorders Clinic
NPH, Pseudotumor Cerebri and CSF Leakage
With special emphasis on normal pressure hydrocephalus (NPH), the CSF disorders clinic is geared towards managing a broad category of cerebrospinal fluid (CSF) disorders. Our approach focuses on ruling out the many conditions that can mimic NPH and other CSF disorders, first. Then, once a diagnosis is confirmed, our care team is trained to provide the full range of services our patients need.
The clinic is a result of a collaboration between the Neurology and Neurosurgery staff members of Mount Auburn Hospital, and is additionally aided by other services such as radiology, neuropsychology and physical therapy.
We provide all available services for treatment; this includes medical and surgical treatment. If you are diagnosed with NPH a surgical procedure will be performed to relieve the increased CSF build-up inside the brain
To access an example of a patient treated by our providers, follow this link:
New England Journal of Medicine
This is a video a patient diagnosed by our providers with NPH, showing their walking before and after treatment, although this is an example of significant improvement which does not always occur:
VIDEO Additional Resources
Hydrocephalus Association Providers
Mahmoud AbdelRazek, MD Jeffrey Arle, MD
Our neurology specialists also work with experts in:
What to expect during your first clinic visit
During your first visit to the CSF disorders clinic, our providers will have reviewed any of your records available to them through our electronic medical record system, or that which you have provided by mail or fax to our clinic.
Our providers will perform a full neurological examination.
They will go over your brain imaging with you, and give you their medical opinion.
Additional testing will usually be requested.
A return to our clinic on a separate day for a spinal tap to extract cerebrospinal fluid (CSF) from the back may be a next step, if our providers believe this will aid your diagnosis and treatment.
How to prepare for your first clinic visit
We ask that you mail a copy or fax over any outside records, including doctors’ notes and brain imaging done.
We also ask that you provide us with CD’s of any brain MRI or head CT done outside the Mount Auburn healthcare system. You can check with our staff over the phone what healthcare records within the Boston area we already have access to.
Research Advisory Board; be a part of decision-making in research
Our hospital is a Harvard teaching hospital and clinical research is important to us at the Neurology clinic. We welcome our patients to take part in the process of choosing what research ideas should be implemented. This can be achieved by being a part of our Neurology Research Advisory Board. This advisor board includes doctors, patients, patients' family members, physical therapists, financial administrators and others. For more information or if you would like to participate, please contact us at
NRAB@mah.harvard.edu. About Normal Pressure Hydrocephalus (NPH) and other CSF Disorders
CSF is normally produced inside cavities inside the brain (called ventricles) and flows full the ventricles and surround the brain and spinal cord. It is then reabsorbed into the blood stream. CSF disorders include conditions in which there is a disturbance (increase or decrease) in the amount of circulating CSF or the CSF pressure inside the head; resulting in numerous symptoms varying from headache to a dementia-like picture. The most common examples of these are:
Normal Pressure Hydrocephalus (NPH), which is believed to be resultant from reduced reabsorption of the CSF resulting in enlargement of the brain ventricles and causing symptoms that mimic dementia (like Alzheimer’s disease), with specific occurrence of difficulty walking and incontinence of urine along with the memory problems.
Idiopathic Intracranial Hypertension (IIH), previously known as Pseudotumor Cerebri, which is believed to be due to an increase in the pressure of the veins draining the brain. It typically occurs in young women and results in mainly a headache not responding to analgesics and blurring of vision.
CSF leakage, which most commonly occur after trauma but not necessarily and results in low pressure inside the brain. This mainly presents with a headache that is unresponsive to analgesics.
In patients suspected to have normal pressure hydrocephalus (NPH), our providers may need to monitor your walking, with video recording, before and after a spinal tap.
A spinal tap may also be necessary to monitor the CSF pressure in patients suspected to have idiopathic intracranial hypertension (IIH), previously known as pseudotumor cerebri.