Doctors find the management of normal pressure hydrocephalus (NPH) difficult because their diagnosis is often uncertain and the treatment with shunt surgery carries a significant risk. With the aim of bringing to the attention of clinicians the useful, but largely anecdotal information available regarding this problem, this chapter will address the following: epidemiology, reasons why the diagnosis is difficult, differential diagnosis, features of the history, examination, neuropsychological assessment, radiologic evaluation, and special tests that may help clinicians with management. The review will also address how to measure surgical outcome, surgical complications, and choice of shunt. Lastly, it will discuss associations with idiopathic NPH that might have bearing on the etiology. This chapter presents a practical approach to the management of patients with NPH. Continuum Lifelong Learning Neurol 2007;13(2):144-164.