Links to our NPH_Friends Yahoo Health Group Home Glossary of Terms Helpful Hints Links Forum Guidelines Shunt Settings NORMAL PRESSURE HYDROCEPHALUS
INTRODUCTION
The
message board for Normal Pressure Hydrocephalus
was introduced in
February 2005 because the profile for NPH differs
considerably from
other types of
hydrocephalus. The
purpose
of this web site and message
board is for patients and family members to learn
more about NPH, ask
questions, and share
personal experiences and advice. The goal is
to enable you and
your family to make informed
decisions. Download
and
print a TRI-FOLD
BROCHURE
(PDF) about NPH. We have just
relocated the original site to another server in April 2017, so please
bear with us while we check and fix links.
You'll find a link
near the middle of this page that allows you to join
this Yahoo! Health
Group. It is a members only
moderated list. Before
joining, we urge you to read about NPH on this
page
as
well as excellent articles linked from the page.
Our members are from
all over the U.S.A. as well as Canada, Australia,
Spain,
and the
U.K. We've had visits from every state in
the U.S. and
many other countries, including Armenia,
Australia, Bahamas,
Brazil,
Canada, China, Cyprus,
Denmark, Finland,
France, Hong
Kong,
Hungary,
Korea (Republic of), India, Ireland,
Israel,
Italy,
Jamaica, Japan, Malaysia,
Mexico,
New
Zealand, Netherlands,
Nigeria,
Norway, Philippines, Russian
Federation,
South
Africa, Spain,
Switzerland, Taiwan,
Thailand,
Turkey, United
Kingdom
and
Zimbabwe.
Our
hearts and prayers are
for every family who is going through this
experience, and especially
for those whose circumstances may prevent them
from obtaining the
health care and support they deserve.
In a normal brain, cerebral
fluid flows into and out, with a percentage of
fluid being
absorbed in the brain. In a person with
hydrocephalus, Cerebrospinal
fluid
(CSF)
begins to build up in the brain, causing
the ventricles of the brain to expand and put
pressure on certain
nerves.
In a case of
Normal
Pressure Hydrocephalus, there is no blockage of
the flow of fluid
out of the brain, but the fluid is no longer
absorbed at the rate
needed. Except for occasional
spikes in
pressure, the CSF pressure is "normal". Many
neurologists and
neurosurgeons believe that "Normal Pressure
Hydrocephalus" is a
misnomer, and instead may refer to the condition
as "chronic adult
onset
communicating (non-obstructive) hydrocephalus."
As you read
about NPH,
you may need to refer to a GLOSSARY
OF
TERMS.
The symptoms of NORMAL PRESSURE
HYDROCEPHALUS may mimic those of
Alzheimer's, Parkinson's Disease, and other types
of Dementia, making
NPH
more difficult to diagnose. Although
Alzheimer's patients may
eventually develop gait disturbance and
incontinence, with Normal
Pressure Hydrocephalus, gait disturbance tends to
present first,
then incontinence,
and last, dementia. With Alzheimer's
Disease, confusion and
dementia are the first symptoms to appear, with
other symptoms
developing later in the progression of the
disease. Similar
symptoms may appear in Small Vessel Disease,
Alzheimer's Disease,
Parkinson's Disease, Dementia With Lewy Bodies, or
a number of other
neurological conditions. Dementia and
weakness in the arms and
legs may also be caused by medication, vitamin
deficiency (such as
B12), or chemical imbalance Primarily
NPH is seen in adults over 55 (the median age is said to be mid-70s),
and they may have a variety of symptoms caused by more than one medical
condition or disease. Any of the symptoms below may be caused by other
medical and neurological conditions, and may not indicate NPH. A
patient may have more than one neurological disorder. Normal Pressure
Hydrocephalus is estimated to represent 5% - 10% of all cases of
dementia.
The TRIAD
of symptoms
for NPH: GAIT DISTURBANCE which may include:
URINARY URGENCY OR INCONTINENCE which may include:
Bowel incontinence is not as common, but also may be a symptom of NPH. DEMENTIA which may include:
DIAGNOSIS Initial
diagnosis may be
done by the family doctor who takes a
history of the appearance of
symptoms, observes the patient's gait and
cognitive skills, and rules
out other causes of these symptoms.
The first clues may be the
order in which the symptoms appeared, and
the way in which the patient
answers the doctor's questions.
The
next step should be a referral to a
neurologist for further
testing, including further cognitive tests and
possibly an MRI and CT
scan. Normal Pressure Hydrocephalus may
be diagnosed based on
what the scans reveal. It must be noted
that other neurological
conditions may cause the enlargement of the
ventricles, so tests may be
inconclusive. Based on the patient's history of symptoms
(when and in what order they
appeared), observation of the
patient's gait and cognitive
function, the results of the scans, and
ruling out any other obvious
cause of symptoms, the neurologist may
diagnosis NPH and refer
the
patient to a neurosurgeon. A lumbar
drain may assist in
predicting
the outcome of installing a programmable
shunt. This
requires several days of hospitalization. TREATMENT Typically,
the
recommended treatment for Normal Pressure
Hydrocephalus is the
installation of a ventriculoperitoneal
shunt
to monitor and
drain the fluid from the brain. The procedure is
done under general
anesthesia. A catheter is placed into one
lateral ventricle and
attached to a cap and valve positioned below the
scalp. Tubing is
tunneled below the skin from the valve to drain
into the abdominal
cavity, where it is absorbed by the
body. Generally, the
patient will be in the hospital two to three days.
Usually,
there is only minor discomfort at the site of the
small
incision in the scalp and the abdomen. It
takes a little time for
an older person to recover from the general
anesthesia and adjust to
the changes in the brain, and this varies from
patient to
patient. Improvement may come gradually over
a period of months.
RISKS
There is a risk of infection with any type of
surgery. With shunt
surgery, the risk is greatest during the surgery
and hospital
stay. An infection in the spinal fluid may
not be diagnosed for
several weeks after surgery, and would require the
removal of the
shunt, treatment with IV antibiotics for at least
ten days, and
replacement of the shunt.
Older people tend to have additional medical
conditions such as heart
or lung disease, high blood pressure, diabetes,
arthritis, or other
neurological conditions such as Parkinson's
Disease or stroke. As
they
become less mobile, there may be added
complications from poor
circulation and infection. As people
age, the veins in
the scalp stretch and become thinner, so there is
a risk of a hematoma
(bleed), particularly at the site of the
valve. It's
important to understand all of the implications of
surgery, so be sure
to do your research in advance.
Understandably, many doctors are
reluctant to perform surgery on a patient who is
not in good health and
does not have a good prognosis for recovery Sometimes
the shunt may need to be adjusted for proper
drainage, and in an adjustable shunt, this can be
done by the
neurosurgeon in the office by using a
magnet. Although it's rare,
the valve may malfunction.
The tubing may get
clogged. For some children who live a
lifetime with a
shunt,
complications may occur every several years.
For an elderly
patient, it may never happen in his or her
lifetime.
The earlier a patient is diagnosed and treated, the better the outcome of surgery. As the condition progresses, putting pressure on brain tissue and nerves, there may be permanent brain injury. Studies have shown that cognitive function improves the least after surgery, with gait and urinary incontinence improving more significantly. If you and your loved one decide on surgery, try to have realistic expectations. You may see subtle improvement over many months, or dramatic improvement in days. Some symptoms may improve more than others. Most experts agree that the symptom most likely to improve is gait, and the least likely is cognitive function. Patients who have symptoms from other medical conditions may not experience a dramatic improvement. Most of us who have been through the process would say, "Just appreciate each day and every small miracle." TYPES
OF HYDROCEPHALUS
AS DEFINED BY
THE HYDROCEPHALUS
ASSOCIATION
HOW NPH IN OLDER
ADULTS MAY DIFFER IN
SYMPTOMS
These are simply our observations based on personal experiences, research, and encounters with other NPH patients and families. Be aware that a patient with Normal Pressure Hydrocephalus also may have symptoms from other medical conditions. Some of the ways NPH symptoms of older patients (60's-80's) appear to differ from other similar conditions:
You'll
find LINKS below
to excellent information about Normal
Pressure
Hydrocephalus and related
conditions.
The purpose of this group is to share information and lend support to patients and families. Anyone seeking information and support is welcome to participate or just lurk. It is a very active list, so if you do not want a lot of individual list e-mails, you may select the option to read messages on the web. Visit
the
Yahoo Groups Message Board for NPH_Friends:
https://groups.yahoo.com/neo/groups/NPH_Friends/info
HYDROCEPHALUS ORGANIZATIONS So many have benefited from your information and advice!
Helpful Online VIDEOS at YouTube
Personal Stories of NPH Shunt & Surgical Information Additional
Information About
Dementia &
Diseases of
Aging
Dementia (Main Page) - E-Medicine - Excellent explanations about causes and symptoms of Dementia
http://neurotalk.psychcentral.com/forum14.html http://www.dailystrength.org/c/Hydrocephalus/forum http://neurosurgery.mgh.harvard.edu/pedi/hyceph-l.htm Disclaimer:
All
information included on this site is believed to
be accurate but is
not guaranteed. Each case of NPH is
different. This Yahoo Group
is independent from any organization, and is
offered as an opportunity
to learn and share information about Normal
Pressure Hydrocephalus.
Members and owners are not medically trained and
make no claim to be
such, do not intend to advise or otherwise act as
medical
professionals. This website disclaims any and all
liability for injury
or other damages that could result from use of the
information obtained
from this site.
Normal Pressure Hydrocephalus Support Group ©2005-2017 Go to NPH_Friends Yahoo Group normal
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