Patient-Informed Biomechanical Modeling Reveals Mechanical Mechanism of Brain Damage in Idiopathic Normal Pressure Hydrocephalus

Vahid Darvishi, Martina Del Giovane, Michael C B David, Balvinder K Dhillon, Magdalena A Kolanko, Anastasia Gontsarova, Paresh A Malhotra, Christopher Carswell, David J Sharp, Mazdak Ghajari

Smart Medicine, 2026

Abstract

Idiopathic normal pressure hydrocephalus (iNPH) is a growing neurological disorder in older adults, radiologically characterised by enlargement of the brain's ventricles, but it remains unknown whether ventricular enlargement can generate mechanical loading large enough to damage brain tissue. We built an anatomically detailed biomechanical model of the ageing brain and applied ventricular enlargement using three-dimensional displacement fields derived from MRI of iNPH patients and age-matched controls. The model reproduced key radiological markers of iNPH, including the Evans index, callosal angle and high-convexity sulcal narrowing, and predicted large mechanical strains in periventricular white matter — particularly the corona radiata, corpus callosum and anterior thalamic radiations, tracts consistently implicated in iNPH imaging abnormalities. These findings provide strong evidence that ventricular enlargement induces mechanical strain that contributes to iNPH brain abnormalities, which could potentially be reduced by shunting surgery. The biomechanical model forms the foundation of a future digital twin to support diagnosis, patient stratification and treatment planning in iNPH. This is the published, peer-reviewed version of the earlier bioRxiv preprint.

Cite as (BibTeX)

@article{darvishi-2026-patient-informed-biomechanical-modelling-2,
  title={Patient-Informed Biomechanical Modeling Reveals Mechanical Mechanism of Brain Damage in Idiopathic Normal Pressure Hydrocephalus},
  author={Vahid Darvishi and Martina Del Giovane and Michael C B David and Balvinder K Dhillon and Magdalena A Kolanko and Anastasia Gontsarova and Paresh A Malhotra and Christopher Carswell and David J Sharp and Mazdak Ghajari},
  journal={Smart Medicine},
  volume={5},
  number={5},
  pages={e70060},
  year={2026},
  doi={10.1002/smmd.70060}
}