By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

EARLY DIAGNOSIS AND SURGERY CAN REVERSE NPH SYMPTOMS

Question: Recently I took my mother to the doctor because she seems to be declining. She is only 66 but is having trouble walking, thinking and is losing her urine frequently. She was fine until she fell about a year ago. She has gone downhill steadily since then, even though the fall just caused a minor bump on the head. What do you think may be going on? A friend suggested she might have something called NPH that she had heard about on TV.

Answer: It’s possible you’re friend might be on to something. The symptoms that you describe -- unsteady walking, dementia, and incontinence -- are all common with NPH. The full name for this brain disorder is normal pressure hydrocephalus, and it’s a relatively new malady, only having been described for the first time in 1965.

NPH occurs when the natural flow of cerebrospinal fluid in the brain is blocked. This causes an abnormal increase in the amount of this fluid in hollow spaces (cavities) called ventricles. As the fluid fills up the ventricles, they enlarge and put pressure on brain tissue. The person may lose any or all brain functions that are controlled by the region of the brain that is being compressed.

This condition can develop after a head injury but may occur for no apparent reason. While it’s most common in the elderly, it can occur at any age. Fortunately, it is sometimes reversible with proper treatment.

NPH is easily confused with Alzheimer’s disease, Parkinson’s disease and Creutzfeldt-Jakob disease. This is because these diseases can all have one or more of the symptoms you mentioned. According to the National Institutes of Health (NIH), normal pressure hydrocephalus is thought to account for about 5 percent of all dementias.

Generally in NPH, the change in gait is the first noticeable symptom. Patients usually develop a slow, wide-based gait. They may describe their feet as being “stuck to the floor.” The next step, typically, involves urinary problems, as they may develop frequent urination and have difficulty completely emptying the bladder. Finally, patients may develop some level of dementia.

An MRI and a spinal tap (lumbar puncture) will lead to the correct diagnosis in most cases. After a diagnosis has been confirmed, the excess cerebrospinal fluid will be drained either periodically or with a permanent shunt. The treatment of choice, according to the NIH, is the surgical creation of a shunt that routes the cerebral spinal fluid around the obstruction and back into circulation.

Your mother needs to get to a physician. He or she will probably recommend consultation with a neurologist. Unless the physical examination and history reveal another more likely culprit, it’s likely your mother will be given the tests I mentioned to confirm or rule out NPH. If it is NPH, a surgical treatment will be recommended. While these are effective in about half the cases, I must add that the best prognosis is for those who are diagnosed early when their symptoms are minimal. In these cases, a properly installed shunt may be able to reverse many, if not all of the NPH symptoms.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.