The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on the lumbar infusion test for the investigation of normal pressure hydrocephalus.


Normal pressure hydrocephalus (NPH) is a condition in which a clear, colourless fluid called cerebrospinal fluid (or CSF) accumulates around the brain and spinal cord. Symptoms include abnormal gait, urinary incontinence and impaired cognitive function. NPH can be managed by surgical intervention, for example with shunt surgery. The lumbar infusion test may be useful for selecting those patients who are most likely to benefit from this type of surgery. This test involves the insertion of a lumbar needle through the skin of the lower back into the spinal sac, recording the pressure of the CSF as fluid is infused into the spinal sac.

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.