Introduction: Among the confirmed cases of hydrocephalus in the Middle East, there is no standardization of care or differentiation between various types of hydrocephalus.This is the first study in the Middle Eastern regions that aims at developing a hydrocephalus clinical protocol for appropriate standard of care.Methods: We used a well-established clinical protocol from Johns Hopkins University and adapted it to a locally relevant clinical context with the help of an interdisciplinary panel of experts.The final protocol included diagnostic radiology studies, lumbar punctures (LP) as indication for surgery in hydrocephalus patients, and standardized times for follow-up visits were scheduled for optimal management of care.Baseline and follow-up testing protocol included gait assessment scales [Tinetti Gait and Balance Scale, Timed Up and Go task (TUG)] and ICIQ Urinary Incontinence short form.Results: Key highlights were cultural and language barriers which resulted in editing the testing and measures for use within the region (ex.translation into Arabic, religious beliefs, and education levels were incorporated to modify protocols).Gender roles and space constraints restricted feasibility of gait testing and required invasive procedures (ex.TUG times could not be assessed in a public hallway for women and women demanded inpatient stays for LP). Conclusions:The study highlights the need to raise awareness and standardize clinical protocols for screening and treating NPH in the region.A critical analysis of issues related to the how and why of implementation, and in turn optimizing the appropriateness and relevance to the particular circumstances is essential.