Brain shrinkage in NPH can be reversed after surgery

Imagine if doctors could help a brain grow back after it looked like it was shrinking. That is exactly what new research about Normal Pressure Hydrocephalus (NPH) is starting to show! NPH is a condition that mostly affects older adults and can cause walking problems, memory issues, and trouble holding urine. For a long time, doctors thought that when a brain scan showed shrinkage, or atrophy, it meant brain cells were lost forever. But now, scientists have found something surprising: in some cases, this shrinkage can actually be reversed after the right treatment, giving hope to patients and their families.

What is normal pressure hydrocephalus (NPH)?

NPH is a special kind of brain condition where extra fluid, called cerebrospinal fluid (CSF), builds up in spaces inside the brain called ventricles. Even though there is more fluid, the pressure stays about normal, which is why it is called "normal pressure." This can make the ventricles grow larger and put pressure on the brain. People with NPH often have problems walking, thinking, or controlling their bladder. Sometimes, these symptoms are mistaken for other diseases like Alzheimer's, making it hard to get the right diagnosis. For more about healthy brain aging and ways to lower dementia risk, you can check out this SlothMD article on reducing Alzheimer’s risk.

Diagnosing NPH and why it is tricky

When doctors look at MRI scans of people with NPH, they usually see that the ventricles inside the brain are much bigger than normal. But here is the tricky part: big ventricles can also happen when the brain loses tissue, or atrophies, due to aging or diseases like Alzheimer’s. This makes it tough to tell if someone has NPH (which can be treated) or another brain disorder (which often cannot be reversed). In fact, studies have shown that many older adults are misdiagnosed, and some do not get the right treatment because brain shrinkage on a scan is assumed to be permanent (see this large study of NPH patients).

Can brain shrinkage be reversed?

A new study looked at the brains of 30 people with NPH before and after they had a special operation called a ventriculoatrial (VA) shunt. This surgery helps drain the extra CSF fluid out of the brain and into the body, relieving the pressure. The scientists used advanced computer tools called volBrain and vol2Brain to measure very carefully the sizes of different parts of the brain on MRI scans.

The results were exciting! After surgery, most patients showed a clear increase in both gray matter (the thinking part of the brain) and white matter (the connecting fibers), as well as a decrease in the amount of extra fluid. This means that what looked like permanent brain shrinkage was actually something called “cerebral pseudoatrophy”—it only looked like the brain had shrunk, but with the fluid gone, the brain could bounce back. These findings were published in Scientific Reports in 2025.

How does brain tissue recover?

Scientists believe the brain acts a bit like a sponge. When too much fluid builds up, it pushes on the brain and squashes it. Once the fluid is drained away, the brain has room to expand and recover. This is different from other brain diseases, where cells are lost for good. The study showed that after shunt surgery, the brain’s gray and white matter increased by several percent, and patients improved in their walking, memory, and bladder control.

Why do these results matter?

This discovery is important because it can help more people with NPH get the right treatment. If doctors see brain shrinkage on an MRI, they should not automatically assume it is permanent. Instead, they now know that in NPH, surgery can reverse some of the shrinkage and help patients feel better. It also highlights the power of health AI tools like volBrain to give precise information that simple eye exams might miss.

The future of brain scans and patient care

As health AI and advanced MRI tools become more common, doctors can make better decisions for their patients. For anyone concerned about sharing their MRI or health data online, you can read this SlothMD article on keeping your health data private.

Research like this shows that the brain can be more resilient than we thought, at least for certain conditions like NPH. With careful diagnosis and new technology, patients may have a real chance to get some of their brain function back, and that is hope worth sharing.