Introduction:
Idiopathic normal pressure hydrocephalus (iNPH) was first described by Dr Hakim and Dr. Adam on1964 in case series described triad of symptoms of difficult walking, dementia and urine incontinence. Diagnosis of iNPH is difficult and should be differentiated from other neurodegenerative diseases.

Objective:
The aim of this study to increase awareness with diagnostic criteria of iNPH that favor the diagnosis and good response to CSF diversion surgery.

Methods:
A retrospective, hospital based descriptive study to evaluate one year outcome of patients were diagnosed with iNPH according to certain clinical and radiological criteria then treated with ventriculoperitoneal shunt in period between 2018to2023. Demographic data were listed, clinical evaluation, radiological specifications, diagnostic measures and algorithm of management were described. Clinical follow up was enrolled.

Results:
Among 69patients were evaluated for possibility of iNPH, 17patients were confirmed their diagnosis. Age mean was 68.5years. 15males(88.2%) and 2females (11.8%). Co-morbidities were multiple lacunar infarcts, diabetes, hypertension, ischemic heart disease, Parkinsonism and Alzheimer's disease. First presentation of all patients was difficult walking with mean duration15.8months. Good response to CSF tapping test after fulfilling the determined radiological criteria. Different degrees of clinical improvement were reported after ventriculoperitoneal shunt insertion.

Conclusion:
Our diagnostic criteria help distinguishing those with iNPH. These criteria could be considered as predictors for good outcome after shunt insertion. Symptoms duration is a cornerstone in determining the degree of improvement. Co-morbidities may affect degree of improvement. Difficult walking is the first symptom to improve. Adjustable valves better to be used.