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Despite its relatively typical imaging features and clinical symptoms, the pathogenesis and pathophysiology of iNPH remain unclear. In this review, we summarize current pathogenetic conceptions of iNPH and its pathophysiological features that lead to neurological deficits. The common consensus is that ventriculomegaly resulting from cerebrospinal fluid (CSF) dynamics could initiate a vicious cycle of neurological damages in iNPH. Pathophysiological factors including hypoperfusion, glymphatic impairment, disturbance of metabolism, astrogliosis, neuroinflammation, and blood\u2010brain barrier disruption jointly cause white matter and gray matter lesions, and eventually lead to various iNPH symptoms. Also, we review the current treatment options and discuss the prospective treatment strategies for iNPH. CSF diversion with ventriculoperitoneal or lumboperitonealshunts remains as the standard therapy, while its complications prompt attempts to refine shunt insertion and develop new therapeutic procedures. Recent progress on advanced biomaterials and improved understanding of pathogenesis offers new avenues to treat iNPH.<\/jats:p>","DOI":"10.1111\/cns.13526","type":"journal-article","created":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T13:15:58Z","timestamp":1606396558000},"page":"1230-1240","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":159,"title":["Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus"],"prefix":"10.1111","volume":"26","author":[{"given":"Zhangyang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology Zhongshan Hospital, Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology Zhongshan Hospital, Fudan University Shanghai 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