Normal Pressure Hydrocephalus (NPH)
A Frequently Overlooked, Treatable condition
- Please help us increase recognition of NPH in Ireland.
- NPH effects older persons, average age 72 years
- Learn to recognize the Gait Disturbance in Seniors
- Know what will be the next symptoms
- Learn about Timed Up Go (TUG) tests
- Consider keeping video records of Gaits of family members as symptoms develop slowly (insidiously).
- Support the installation of more MRI and CT Machines, for better diagnostics.
The timing of the symptoms onset may be the indication that points away from a diagnosis of a far more prevalent condition such as Alzheimer’s or Parkinson’s. Outcomes will be better with more testing.
NPH is caused by the build-up of CSP in the Brain, it sometime referred to as “water of the brain”. This causes the ventricles to expand putting pressure onthe surrounding tissue. (see illustration below). The patients balance is affected
To compensate for the affected balance, the patient, over time, widens their gait. When the patient presents in the doctors office they have a wide gait and “magnetic foot”. This usually the first symptom to appear.
The second symptom to appear over time is urinary urgency or incontinence. Lastly, dementia occurs, this is often mild. Not all symptoms must be present.
The increase in ventricle size will not be seen until CY scans or MRI’s have been taken.
The Spina Bifida Hydrocephalus Ireland Website has a full drescription. Learn More…
Alternatively, Mayfield Clinic’s Site has and illustrated description. Learn More…
Triad of Symptoms
- Gait Disturbance
- Urinary Incontinence
- Dementia
Three Treatment and Tests
- MRI and CAT scans
- Lumbar Puncture Test
- CSF Shunting
Used from: https://mayfieldclinic.com/pe-nph.htm
Figure 1. Cerebrospinal fluid (blue) is produced by the choroid plexus inside the ventricles and is constantly being absorbed and replenished. It circulatese out of the ventricles and into the subarachnoid spaces surrounding the brain and spinal cord. CSF is absorbed by the arachnoid villi along the top of the brain.
Used from: https://mayfieldclinic.com/pe-nph.htm
Figure 2. In normal pressure hydrocephalus, an excess of CSF enlarges the ventricles, stretching the brain and causing symptoms.
The enlarged ventricles can be seen on a CT scan. Luckily there are more CT scanners in Ireland now, compared to previous years. New Head only scanners are being developed and should be on the market by 2023.
Any patient showing 2 of the 3 NPH symptoms deserves a CT Scan. This an investment and not a cost. If the majority of patients scanned don’t have enlarged ventricles, the few that do have enlarged ventricles and go on to treatment will more than offset the costs.
NPHydro supports further investment in CT Scanners and facilities. And we hope agree.
