Cerebral haemodynamics were measured in 22 adult patients with secondary normal pressure hydrocephalus (NPH) before and after glycerol administration to determine which patients might benefit from a shunt procedure. Of these 22 patients, 14 were found to be shunt-responsive (group 1) and 8 were shunt-unresponsive (group 2). Measurement of regional cerebral blood flow (rCBF) was performed by xenon-enhanced computerized tomography (XeCT). Clinical factors such as the Evans' index and the presence or absence of brain atrophy, periventricular lucency (PVL), ventricular reflux, stagnation of cerebrospinal fluid on cisternography, and increased intracranial pressure were not statistically significant predictors of shunt responsiveness. Preoperative rCBF values did not differ between groups 1 and 2. The rCBF value in every cerebral region of group 1 patients increased significantly after shunting except for the basal ganglia. On preoperative rCBF measurement, all rCBF values in group 1 significantly increased after glycerol administration except for the periventricular lucency (PVL). Patients in group 2, however, lacked such an increase in rCBF. We therefore propose that, in patients with secondary NPH, shunt surgery will be likely to be effective in those with a demonstrated rise in rCBF after glycerol administration.