Are you experiencing memory loss and difficulty walking as you age? It could be Normal Pressure Hydrocephalus (NPH)

Is an elderly person in your household, perhaps your mother, father, or grandmother, becoming increasingly forgetful? Does their feet seem to be dragging on the ground when they walk? Is it also becoming increasingly difficult to control their urine ? We often think of these as "normal things that happen as we get older." But they can also be symptoms of a condition that can be treated and cured. Today we're talking about one such condition, Normal Pressure Hydrocephalus, or NPH.

What is Normal Pressure Hydrocephalus (NPH)?

Simply put, NPH is when more fluid accumulates in our brain than is necessary.

Imagine that our brain and spinal cord, which run down our spine, are surrounded by a clear, cushion-like fluid. In medical terms, this is called cerebrospinal fluid (CSF) . This CSF is produced in the ventricles of our brain and circulates throughout it, nourishing the brain and spinal cord, removing waste products, and protecting the brain from hitting the skull. Normally, excess CSF is drained back into the body through veins on top of the brain.

However, if there is any obstruction in the system that drains this CSF fluid, this fluid starts to accumulate inside the cavities of the brain. This is what we call Hydrocephalus ( water filling of the brain ). NPH is a special type of this Hydrocephalus condition. It is most often seen in people over the age of 60.

Unlike other types of hydrocephalus, NPH develops very slowly. The CSF fluid builds up over time. As a result, the cavities in the brain gradually enlarge, pushing on parts of the brain. This is why the pressure in the brain does not increase suddenly, which is why it is called "Normal Pressure." But that name is a bit misleading, because the symptoms only occur when the cavities enlarge and push on the brain.

Importantly, the symptoms of NPH are very similar to those of Alzheimer's disease and Parkinson's disease . As a result, NPH patients are often misdiagnosed as having one of the other two diseases. However, unlike Alzheimer's and Parkinson's, if diagnosed correctly, NPH can be largely cured with surgery.

The three main characteristics of NPH condition

There are three main symptoms of NPH. These may not be obvious at first, but they gradually increase over time. If all three of these symptoms are present, NPH should be suspected.

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What are the causes of NPH?

In fact, in most NPH patients, no specific cause can be found. However, in some cases, the following factors may contribute to the condition:

• Head injury
• Bleeding around the brain due to a blow to the head
• Stroke
• Infections such as meningitis
• Brain tumor
• Brain surgery

There is still no clear understanding of how these conditions cause NPH.

How is NPH diagnosed accurately?

Now you might be thinking, "Okay, these are the symptoms, now how do I diagnose this?" This is a bit complicated. Because these symptoms are similar to Alzheimer's and Parkinson's diseases, it's important to see a neurologist or neurosurgeon .

The diagnostic process usually goes like this:

1. Talking to the doctor: The doctor will ask you about everything from your symptoms, when they started, family medical history, and medications you take.

2. Physical examination: Your mental state (asking questions and asking you to follow simple instructions), gait, and body balance will be checked.

3. Special tests:

• CT Scan or MRI Scan: These scans can produce detailed 3D images of the brain. They can help determine if the ventricles in the brain are enlarged in NPH. However, a scan alone cannot confirm NPH.
• Lumbar Puncture / Spinal Tap: This is one of the most crucial steps in diagnosis. We sometimes call this a 'spinal tap'. Don't worry, a doctor will do this. A small needle is used to remove some of the CSF fluid that surrounds the spinal cord from the lower back.

This lumbar puncture can be used to check two things. One is to measure the pressure of that fluid. The other important thing is to see if, after removing about 30-50 milliliters of fluid in this way, the patient's gait and memory temporarily improve over the next few hours. If such a significant improvement is seen, it is a good indication that a major recovery can be achieved with surgery.

What are the treatments for NPH?

The most effective treatment for NPH is surgery. No medication or other medical treatment can cure the condition.

The main surgery is to place a shunt.

Imagine a small tube being inserted to drain excess CSF fluid from our brain and send it to another part of the body. This is called a shunt. This is a very thin tube. A neurosurgeon inserts this tube into a cavity in the brain and directs it under the skin to a place called the peritoneum. There is a valve in this tube that controls the pressure. When the pressure in the brain increases, this valve opens and the excess fluid flows into the peritoneal cavity. There, the fluid is absorbed without harming the body.

This shunt surgery is not equally successful for everyone. However, for many people, symptoms are significantly reduced after this surgery and their quality of life is greatly improved. The sooner the disease is diagnosed and the surgery is performed, the more successful the results.

In some cases, instead of a shunt, another surgery called an Endoscopic Third Ventriculostomy is performed, in which an endoscope (a thin tube with a camera) is used to make a small hole in the bottom of a brain cavity to create an alternative path for CSF fluid to flow.