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Normal Pressure Hydrocephalus

By Meg Marinis, Director of Research | Nov 12th, 2009
Imagine being trapped in the past. Or suddenly, you no longer feel familiar in your home. The faces that surround you? Seem strange, almost like you happen to be looking through the glass of a foggy window. Getting up from your seat and walking across the room causes pain, discomfort, and you cannot help but stumble even though the ground may be flat and free of obstacles.

Does this mean you have normal pressure hydrocephalus?

No. Sadly, that description of helplessness happens to fit a variety of diseases that include Alzheimer's Disease, partially Parkinson's Disease, some instances of multiple sclerosis, and dementia. And due to the similarity in presentation, many people never even know that they, or their family members, suffer from NPH. If Dr. Izzie Stevens had never traveled back home to Chehalis, Dr. Singer may never have found out he had the disease..

What exactly is NPH? And who gets it?

A clear liquid, cerebrospinal fluid (CSF), surrounds everyone's brain and spinal cord in order to protect them, supply them with necessary nutrients, and to remove any waste. Produced and kept in the brain's ventricles, the fluid circulates through, eventually draining from the brain and absorbed into body tissue.

When the fluid does not circulate and drain properly, it builds up in the brain's ventricles, causing the condition hydrocephalus. Due to the excessive amount, the ventricles swell in size, putting pressure on surrounding parts of the brain, causing a variety of symptoms. Normal pressure hydrocephalus is a type of the condition that typically affects older adults, usually appearing around the age of sixty. In these instances, the fluid accumulates over time, enlarging the ventricles over a longer period.

Why does it resemble so closely to other diseases?

From the gradual pressure, the affected brain functions include cognitive mental abilities such as memory, speaking, problem solving, and reasoning. Physical symptoms include difficulty walking, loss of bladder control, and frequently, loss of bowel control. Since these symptoms also seem similar to dementia and the disease affects older adults, doctors often initially diagnose these patients with either Alzheimer's or Parkinson's. However, unlike those two devastating illnesses, NPH (if caught early enough) can be treated and mostly reversed. However, symptoms may appear very subtle, therefore diagnosis may not come as easily at first. Any major differences in behavior, regardless of age, grants a visit to one's healthcare provider.

Is it caused by anything? Unfortunately, doctors usually do not know the reason for why someone suffers from NPH. However, several factors certainly may contribute to it such as: Other brain surgeries, a head injury, any bleeding in the brain, a tumor in the brain, meningitis, or a stroke.

How is NPH diagnosed and treated?

Along with a physical exam and interview with one's doctor, the patient will be referred to a neurologist to perform cognitive ability testing. Unfortunately, lab work does not indicate the disease, but head scans such as a CT, MRI, or cisternography may aid in illuminating enlarged ventricles of the brain. Also, like Izzie facilitated in this episode, a lumbar puncture (a spinal tap) may be performed. With the LP, CSF will be removed through the use of a large needle from the area below the spinal cord in the lower back. Often when fluid is removed, symptoms temporarily disappear and then doctors have a positive indication of NPH and can perform surgery to permanently relieve the patient.

Not all patients may be candidates for the surgery due to the progression of the disease or other health problems that come with older age. But if doctors feel surgery would be a benefit, then a neurosurgeon may perform a shunt operation. The shunt, a thin tube inserted directly into the ventricles, will drain the excess CSF away from the brain, keeping symptoms indefinitely away.

For more information, please visit:

http://www.ninds.nih.gov/disorders/hydrocephalus/hydrocephalus.htm

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