Normal Pressure Hydrocephalus Puns

because you're making me wacky, wobbly, and wet

I just don't understand how NPH can cause compression to structures if the pressure is normal. If there is so much fluid that it is squeezing structures then the pressure has to be high somewhere?

I observed an LP on a patient earlier today who may have had NPH with an opening pressure of 7 and have been trying to make sense of this since. They thankfully also found the procedure therapeutic with relief of their headache.

Given that Jreg has been talking about dementia. According to Reader's Digest June 2021 edition, p. 55 states, "NPH is sometimes referred to as 'treatable dementia."' I thought I'd bring it up, esp. since he's making tier lists of different illnesses.

My mother had been slowly declining physically and cognitively for years, up until her balance was so bad, she couldn’t stand without falling backward. Without my helping her every minute of the day, she would have been permanently in a wheel chair - unable to even operate it. Her walking (even with assistance) became a nothing more then a shuffle and she was unable to really pick up her feet when moving - almost as if she were walking through mud. She also had severe freezing episodes with her feet/legs, especially as she was turning to sit (which she would always just flop in chairs) and changes in flooring when walking (ie carpet to tile, etc) - often time it would be so bad she would have fallen had I not been there all the time - just because of a change in flooring.

Cognitively, her memory deteriorated, her ability to engage in conversation all but disappeared, and she was practically unable to understand even mildly “complex” instructions - sequencing was a big no - as was remembering anything procedural that was simple (ie couldn’t remember out how to use the basic features on a remote control to the TV).

Urinary, she was completely incontinent. Didn’t even know she had to urinate until she was already peeing. Not only did I have to help my mother bathroom and clean for 2 years, I also had to sleep next to her in a recliner during that time, to help her to the commode 2-4 a night (and change pads (and sheets if necessary)).

She was diagnosed with Parkinsonism last July, and at the same time, we got her another MRI ordered. I read the report when it came back and saw that it referenced “characteristics of NPH”, a potentially treatable and reversible condition (which I then found had been referenced in MRIs she had back in 2015 and 2017). Experts suspect that there are over 700,000 people in the US suffering from NPH, with only 20% ever getting the correct diagnosis.

The second neurologist we took her to, we asked him if she indeed did have NPH. And he said “no.” “I wouldn’t even order a lumbar puncture”. Which is bizarre, since that’s the final test to truly understand if a person does in fact have the disease. So we got a 3rd opinion at Mass General Hospital where they said “yes, maybe”. We got her the spinal tap, and she showed improvement. So, we then had 2 neurologists and a neurosurgeon at Mass General all agree that she would more then likely benefit from a shunt

She had the implant in February of this year, and is now independent o

I'm not much for TV, but my local hydro group on fb just posted about this. figured I'd pass it along.

Have any of you ever heard of this condition before? I brought my mother to get a neurological work up for the first time (so long overdue I won't begin to admit) and within 5 minutes the neurologist printed out information on this condition. The symptoms of it are unsteady/abnormal gait, urinary incontinence, and dementia (possibly reversible). Relieving cerebrospinal fluid pressure is a form of treatment.

I'd have never thought of a cerebrospinal fluid issue in a million years. I thought dementia is dementia, and it might be vascular if you have diabetes, but it's an otherwise one way street. My mother's story is kind of interesting because she did have marked reversal of what seemed to be a very severe dementia (after major change in diet and 2 months of Donepezil). I had always thought "this is it" with her, but the neurologist sees her case otherwise. We're going to get some more tests done for her so we'll see how this pans out.

For some this information could be very pertinent (as a layperson I certainly did not tie the symptoms together). Definitely seek out a neurologist.

Hi there. This may sound like a strange question, but I was trying to touch base with people who have experience with NPH.

My father had a stroke back in November last year. Since then he's been recovering in some ways but going backwards in others.

In the days after the stroke he had a facial droop and weakness in his right side which has improved gradually.

But one thing that is getting worse is his balance. He uses a cane to get around and has had quite a few instances of falling over while standing, and really struggling to get up off a couch or out of bed.

Compare to the last few years his cognitive abilities haven't changed that much (He's always complained of bad memory).

When he walks he used to stand upright - almost like he was marching. But I recall a time about 3 weeks BEFORE his stroke that his walking pace slowed substantially and he started to develop what we jokingly called his "old man shuffle" (he is 67).

Lately my mother told me that he has developed a urinary incontinence.

I guess the fact that his "changes" started before the official stroke make me wonder if he has had a condition for longer which has been gradually getting worse - in particular, I'm wondering if he should be checked out for NPH.

Would anyone here care to describe their experiences with the condition?

TIA!

I am 37m black united states 280lb 5'6" tall and. I have no conditions besides the one listed in the title normal pressure hydrocephalus and empty cellus I dont have a shunt and I have severe migraines. I stopped seeing my neurologist because he told me that my headaches were not because of the hydrocephalus. I was hospitalized for 1 week when it was first discovered so they could run test I was having blurred vision, dizziness, vertigo, and really fatigue, and body aches, disoriented, and headaches. I do still have these episodes like 3 times a month month they last a1-5 days. I have tried to explain this to my primary care doctor everyone just treat me for the migraine not the other stuff that happens like the vision problems and the disorientation. I always have a slight headache. I have seen eye doctor etc and the only thing that I can comeback to due to my research is normal pressure hydrocephalus but no one will treat me for this.

Can anyone give me your personal guess on how many of the patients referred for normal pressure hydrocephalus actually end up being shunted with effect?

I can't seem to find this in the literature and I'm not sure it exists, either.

I want to use this number to compute the effect of the various (seemingly useless when negative) tests for NPH.

Thank you.

Age - 81
Sex - M
Height - 5'7"
Weight - 180lb
Race - Caucasian
Symptoms - poor balance/shakiness/dizziness, swallowing issues, nystagmus, hand tremors, memory issues
Duration of complaint - worsening over several years
Any existing relevant medical issues (if any): hypertension, hypothyroidism
MRI results (text, no images available): https://imgur.com/a/3YPYjZX

My grandpa got an MRI of his head because he's been having increasing dizziness & cerebral symptoms. The doctor explained that Parkinson's disease or a stroke were possibilities that they were looking into.

These results were automatically released in his online chart, but he isn't able to have an appointment with his doctor until after the new year. No images accompanied these notes. I understand that meeting with the doctor who ordered the results will explain a lot, but my grandparents are pretty stressed during this two-week waiting period before they're able to get an appointment, so any light that you can shed on these results would be much appreciated, particularly whether or not these results rule in or out Parkinson's disease, Alzheimer's, a stroke, or normal pressure hydrocephalus.

Thank you!

For whatever reason, this RR isn't up on the ANST blog yet, just the listserv. So, I thought I'd post it here for those interested.

Normal Pressure Hydrocephalus in Older Adults

Contributor: Danielle Hergert, M.A. – University of South Florida, Clinical Psychology Ph.D. Program

Overview

Communicating Normal Pressure Hydrocephalus (NPH) is a neurologic syndrome often observed in older adults that is characterized by enlarged cerebral ventricles and white matter damage and is associated with the gradual onset of a triad of symptoms: gait disturbance often described as magnetic or shuffling gait, urinary incontinence and cognitive deficits (Hellströme et al., 2007). Cognitive and motivational deficits that are often associated with frontal-subcortical dysfunction, such as executive dysfunction and apathy, are commonly observed (Shprecher et al., 2008).

Communicating normal pressure hydrocephalus is a result of an imbalance between cerebral spinal fluid (CSF) production and reabsorption. Some have suggested that the term “normal” pressure hydrocephalus is a misnomer, because intracranial pressure may or may not be normal. This is in contrast to non-communicating, or obstructive hydrocephalus, which may occur when the CSF system is blocked within the ventricles, for example from trauma or a tumor, and intracranial pressure typically increases. Most cases of communicating hydrocephalus observed in older adults are idiopathic. Other causes of NPH include trauma, hemorrhage, infections (e.g. meningitis), and lesions, as these may cause inflammation within the arachnoid space and can interfere with CSF absorption (Pujari et al., 2008; Shprecher et al., 2008). The prevalence rate of idiopathic NPH has been estimated to be 5.5 per 100,000 (Shprecher et al., 2008; Brean & Eide, 2008).

Treatment in the form of CSF shunting procedures has been demonstrated to alleviate some of the symptoms. To predict which patients may have more favorable outcomes following the procedure, high volume CSF removal via lumbar puncture or external lumbar drainage is typically used and may temporarily ameliorate symptoms. Gait (and sometimes cognition) is tested before and after these procedures to determine the likelihood of improvement following the shunting procedure (Shprecher et al., 2008).

Abstract

Apathy, ventriculomegaly and neurocognitive improvement following shunt surgery in normal pressure hydrocephalus (2015)

Introduction. Apathy – impaired mot

My brother, 57, born with Down syndrome (non verbal), has developed NPH. They discovered it during an MRI to stage Alzheimer's. Had neuro consult today and doc wants to do a spinal tap under sedation in lieu of a shunt to see of that helps some of the neurological symptoms. I'm assuming this will be a single procedure? I'm 2500 miles away and his school's medical staff is handling this. Plus I have family nearby. My guess is that he's taking a conservative approach to see if it helps. Is this a fairly common approach? With my limited medical knowledge it seems to make sense. Will they be doing this once? Or this typically something that will require multiple lumbar punches?

Neurosurgeon doesn’t seem to think it’s a big issue, because my condition is “chronic, not life threatening” if untreated. I understand I’m not as big a priority as emergency hydro patients, but can’t brain damage happen anyway? I’m not projectile vomiting like when I was first dx, but I’m nauseous, have severe head pains, and my cognition and quality of life is getting worse. Phone call follow up in a week but I’ve already been dealing with these symptoms since my ligation surgery 7 weeks ago.

At what point should a ligation be considered? After something like a shunt tap or other testing and imagery? After how many attempts at finding the right valve settings? He refused to do shunt tap on me before. He said a ligation was easier than a revision for my symptoms which could’ve been a shunt malfunction, but also my hydrocephalus could’ve been temporary. Now his only tool is a lumbar puncture which was actually painful last time and becoming a small torture to endure. My LPs have borderline high opening rates due to where my tumor+cyst was that lead to hydrocephalus, but he doesn’t believe me or take into consideration the research my previous neurosurgeon (who recently retired) did which confirms pineal cyst/tumor patients experience hydrocephalus at slightly lower opening pressures than most people. I fear if I have another borderline opening pressure he won’t do anything and I’ll slowly decline, and be stuck with complications from the ligation. Why couldn’t he have done other tests before ligating? Maybe I should have pushed harder? I had 4 or 5 adjustments with my first surgeon over the course of 7-8 months, and this new surgeon didn’t want to try any more settings.

The ligation caused some issues with the incision in my chest, a seroma apparently, which empties and fills almost daily to every 2 or 3 days. My shunt tubing is also very tight now and I can’t even extend my neck on the side with the tubing, or pivot my neck some days.

This is a new surgeon and I’m a vulnerable person who doesn’t do well with doctors anymore (autistic and now medical ptsd), and I don’t know if my experience with this new guy is normal in any way. I advocate for myself but I’m afraid of coming across as argumentative. My family have no idea what I should do or how to support me. I feel like I’m losing my mind out of worry and legit illness impacting my every moment. Is it time for a second opinion? My only other option may be to go out of state, where I only ha

The extra section of the card goes on to state "rarely occurs due to increased production of CSF by choroid plexus papilloma."

If this is the case, then what is the difference in pathology between communicating high-pressure hydrocephalus and normal pressure hydrocephalus? I thought both were due to decreased CSF absorption, with the difference being that you also have increased CSF production in communicating high pressure hydrocephalus.

Basically title. The neurosurgeon explained to me that I have hydrocephalus/enlarged ventricles but it's compensated. The MRI shows a "bifrontal diameter" of 6,2 cm and says this is enlarged, but what is a normal sizer for this?

I'd like to thank the market manipulators for arranging this wonderful sale on moon tickets. Something shaped like a gorilla deep within my heart tells me not a soul here is selling, and this dip looks absolutely delicious.

It also keeps telling me "those m'fers should have never shot me - i am a benevolent but vengeful god", but I have no clue what that's about.