Hydrocephalus is a condition in which there is too much cerebrospinal fluid (CSF) in the ventricles. The brain and spinal cord are surrounded by clear fluid or CSF. This fluid is produced and stored in cavities in the brain called the ventricles. Cerebrospinal fluid circulates around the brain, moving from the ventricles to the ventricles. The purpose of this fluid is to cushion and protect the brain and spinal cord, supply nutrients, and remove some of the waste products from the brain’s metabolism. Any excess fluid channels from the brain and absorbed by the brain’s blood vessels.
Hydrocephalus occurs when a system that is supposed to drain and absorb cerebrospinal fluid is not working properly. The ventricles eventually enlarge their space to accommodate this extra fluid and then press different parts of the brain, causing a number of different symptoms. Hydrocephalus has many different causes. Some people are born with this condition, while others experience it during their lives.
Normal pressure hydrocephalus (NPH) is a type of hydrocephalus that usually occurs in older adults. The average age of people with NPH is above 60 years. NPH is different from other types of hydrocephalus and develops slowly over time. CSF drainage is blocked gradually, and excess fluid builds up slowly. Slow ventricular enlargement means that fluid pressure in the brain may not be as high as other types of hydrocephalus. However, an enlarged ventricle still presses on the brain and can cause symptoms (the term “normal pressure” is somewhat misleading, even though it means that the pressure is increasing little by little).
The parts of the brain that are most commonly affected in NPH are the parts of the brain that control the legs, bladder, and “cognitive” mental processes such as memory, reasoning, problem solving, and speaking. Decreased mental processes if severe enough to interfere with daily activities, known as dementia. Other symptoms include abnormal gait (difficulty walking), inability to hold urine (incontinence), and, sometimes, inability to control the stomach.
Symptoms of NPH dementia can be similar to Alzheimer’s disease. Problems walking are similar to Parkinson’s disease. Experts say that many cases of NPH are diagnosed as one of these diseases. The good news is that, unlike Alzheimer’s and Parkinson’s, NPH can be cured in many people with the right treatment. But first the diagnosis must be correct that it is indeed NPH.
Causes of Normal Pressure Hydrocephalus (NPH)
Normal pressure hydrocephalus can occur after a head injury, bleeding around the brain caused by a blow to the head, stroke, meningitis, or brain tumor. This can also occur after surgery on the brain. How is the mechanism of these conditions to cause NPH is still unclear. In most cases, the cause of NPH is never known.
Symptoms of Normal Pressure Hydrocephalus (NPH)
At first, the symptoms can be very subtle but get worse gradually.
Symptoms of dementia which include:
- Memory loss
- Speech disorders
- Apathy (indifference) and withdrawal
- Changes in behavior or mood
- Difficulties in reasoning, attention, consideration, or judgment
- Problem is walking
- Limb Weakness
- Sudden fall
- Difficulty taking the first step, as if your feet are stuck on the floor
- The road looks stiff
- Inability to hold urine
- Inability to hold stool
- Frequent urination
- Pee out just like that
The following symptoms can be related to increased pressure in the brain:
- Nausea or sudden vomiting
When to seek medical treatment for normal pressure hydrocephalus?
Some people think that memory loss, difficulty finding words, walking problems, or urinating problems are a normal part of aging. In many cases, if this is due to Normal Pressure Hydrocephalus, then the symptoms can be treated.
Diagnosis of Normal Pressure Hydrocephalus (NPH)
Symptoms of normal pressure hydrocephalus can also occur with Alzheimer’s disease and Parkinson’s disease. However, a combination of dementia symptoms such as walking problems, and urination problems should be considered by doctors as a possible NPH. Making a comparative diagnosis to look for other possibilities is very important because the treatment of this condition is very different.
At any point in the process of finding a cause, the healthcare provider can refer the patient to a neurologist or neurosurgeon to evaluate and begin treatment.
The evaluation begins with a medical history (interview). The doctor will ask questions about existing symptoms and when symptoms begin, current and past medical and mental problems, family medical problems, medications that have been consumed now and in the past, work and travel experiences, and later habits and lifestyle with a detailed physical examination to document the patient’s condition and rule out other disorders that might cause the same symptoms. The examination may include mental status tests, such as answering questions and following simple instructions. Neuropsychological examination can be done to document symptoms of dementia in patients.
Neuropsychological assessment is the most accurate method for pinpointing and documenting one’s cognitive problems and strengths.
There are no laboratory tests that confirm the diagnosis of NPH. Laboratory tests are carried out to rule out conditions that can cause the same symptoms.
- CT head scan: X-ray scans provide a more detailed 3-dimensional image of the brain. Cannot confirm the diagnosis of NPH, but can show ventricular enlargement or other changes that lead to NPH. CT scan is safe and painless.
- MRI head: This scan uses strong electromagnetic wave signals to create a detailed picture of the brain. MRI is safe and painless, like a CT scan, but takes longer (about 30 minutes). MRI also cannot confirm the diagnosis of NPH.
Other tests to evaluate normal pressure hydrocephalus
Lumbar puncture: This procedure involves taking CSF from the area around the spine in the lower back. CSF pressure is measured, and the discharge released is analyzed for abnormalities that might provide clues about the problem
Treating Normal Pressure Hydrocephalus (NPH)
Hydrocephalus normal pressure is generally incurable. This is a long term condition. However, many people with the condition get significant assistance through surgery. For those who are not recommended for surgery, treatment consists of steps to ease mood and behavior problems, overcome physical problems such as urination problems, difficulty walking, and maximize physical, mental, and social functions.
An individual with normal pressure hydrocephalus must always be under the care of a medical professional. Much of the daily care, however, is handled by families and caregivers. Medical care must focus on optimizing individual health, safety, and quality of life while helping family members overcome the many challenges of caring for a loved one with dementia and other symptoms of NPH.
The level of care needed by people with NPH varies. Those who undergo shunt surgery or shunt success can continue to live independently normally or close to normal. Other people will experience symptoms worsened over time. Many of these people will eventually need close supervision and care. The neurologist or neurosurgeon must discuss with you and your family what to expect over time.
It’s important to know that there are no drugs or other medical treatments.
Hydrocephalus normal pressure is not caused by structural abnormalities, such as brain tumors. In most cases, the underlying problem is unknown or not treatable. The treatment in this case is a shunt operation.
Shunts are thin tubes implanted in the brain by a neurosurgeon. The shunt will be inserted into the ventricle to drain excess CSF away from the brain. This shunt tube is channeled under the skin from the head to other parts of the body, usually in the peritoneum (lower abdomen). The shunt is equipped with a valve that opens to release fluid when the pressure rises, then is absorbed by the bloodstream. The pressure regulation on the valve must sometimes be adjusted again by re-operation in a few years later.
Shunt surgery does not cure. It does not treat the underlying cause of NPH. But the installation of a shunt can relieve symptoms.
Shunt surgery does not work well for everyone with NPH. Consult with your doctor about this.
Follow up on NPH treatment
If someone has NPH, patients should visit regularly to a neurologist or neurosurgeon. This visit allows the doctor to monitor symptoms. Changes in symptoms may require adjustments in treatment.
There is no known way to prevent NPH. A healthy lifestyle, including not smoking, maintaining an ideal body weight, and regular exercise, can help avoid conditions such as high blood pressure, heart disease, diabetes, and stroke that might contribute to NPH. Wearing a helmet, seat belts when driving can help avoid head injuries, another cause of NPH.