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What is Normal Pressure Hydrocephalus (NPH)

Posted Jul 02 2009 10:12pm
Previously I wrote about Jimmy Nowells. Jimmy was first diagnosed with Parkinson's and then Alzheimer's. After ten long years, and thanks to the persistence of his daughter--the nurse--Jimmy was finally diagnosed correctly--he suffered from Normal Pressure Hydrocephalus (NPH).

See When Alzheimer's isn't Alzheimer's -- It's a Miracle.

Jimmy's case is not an isolated experience. I already received three emails describing similar circumstance.

You might want to share these two articles with others you know suffering from Alzheimer's. They might want to discuss this with their doctor.
The symptoms of NPH can occur in Alzheimer disease and Parkinson disease. However, the combination of dementia-like symptoms, walking problems, and urinary problems should alert your health care provider to the possibility of NPH. Making the distinction is very important because the treatments for these conditions are quite different. Tests are available that can confirm the diagnosis. At any point in this process, your health care provider may refer you to a specialist in brain disorders (neurologist or neurosurgeon) to complete the evaluation and begin treatment.
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What is Normal Pressure Hydrocephalus?

Normal pressure hydrocephalus (NPH) is an abnormal increase of cerebrospinal fluid (CSF) in the brain's ventricles, or cavities. It occurs if the normal flow of CSF throughout the brain and spinal cord is blocked in some way.

This causes the ventricles to enlarge, putting pressure on the brain. Normal pressure hydrocephalus can occur in people of any age, but it is most common in the elderly population.

NPH may result from a subarachnoid hemorrhage, head trauma, infection, tumor, or complications of surgery. However, many people develop NPH even when none of these factors are present. In these cases the cause of the disorder is unknown.

Symptoms of NPH include:
  • progressive mental impairment and dementia,
  • problems with walking,
  • and impaired bladder control leading to urinary frequency and/or incontinence.
The person also may have a general slowing of movements or may complain that his or her feet feel "stuck."

Because these symptoms are similar to those of other disorders such as Alzheimer's disease, Parkinson's disease, and Creutzfeldt-Jakob disease, the disorder is often misdiagnosed. Many cases go unrecognized and are never properly treated.

Doctors may use a variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar catheter, intracranial pressure monitoring, and neuropsychological tests, to help them diagnose NPH and rule out other conditions.

In September 2005 an international team of scientists developed clinical guidelines to help physicians diagnose NPH.

The guidelines were published as a supplement to the journal Neurosurgery ("Diagnosing Idiopathic Normal-pressure Hydrocephalus," Vol. 57(3), Supplement: S2-4--S2-16, 2005).

Is there any treatment?

Treatment for NPH involves surgical placement of a shunt in the brain to drain excess CSF into the abdomen where it can be absorbed. This allows the brain ventricles to return to their normal size. Regular follow-up care by a physician is important in order to identify subtle changes that might indicate problems with the shunt.

What is the prognosis?

The symptoms of NPH usually get worse over time if the condition is not treated, although some people may experience temporary improvements. While the success of treatment with shunts varies from person to person, some people recover almost completely after treatment and have a good quality of life.

Early diagnosis and treatment improves the chance of a good recovery.

What research is being done?

Research on disorders such as normal pressure hydrocephalus focuses on increasing knowledge and understanding of the disorder, improving diagnostic techniques, and finding improved treatments and preventions.

Source: National Institute of Neurological Disorders and Stroke

Bob DeMarco is an Alzheimer's caregiver and editor of the Alzheimer's Reading Room. The Alzheimer's Reading Room is the number one website on the Internet for insight into Alzheimer's disease. Bob taught at the University of Georgia, was an executive at Bear Stearns, the CEO of IP Group, and is a mentor. He has written more than 600 articles with more than 11,000 links on the Internet. Bob resides in Delray Beach, FL.


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