Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Normal Pressure Hydrocephalus??

Forum: Neurology Forum
Topic: Hydrocephalus


I have been doing some research on normal pressure hydrocephalus due
to a situation we have with my father-in-law. What I am reading indicates that
the term "normal pressure hydrocephalus" means an excessive buildup of CSF
in the ventricles of the brain. However, according to my father-in-law's
neurosurgeon, his CSF was building up "on the top of his brain, not in his
ventricles as you would expect." Two holes were drilled in the top of his head
to relieve the excess fluid and pressure, and then a permanent shunt was
installed in his spine to keep it from coming back. He does still have
delusions and some paranoia and confusion, but I have seen some improvement
in the last few weeks in the area of handwriting, spelling words correctly,
improved steadiness on his feet, etc. He did not have a problem with
urinary incontinence, as seems to be expected with NPH.

Have you any experience with this type of CSF buildup? His doctors suspect
some type of brain damage from the pressure. Can we expect any
improvement, and what can we do to help him?

Thanks for your time and help.

Ann

Dear Ann,

Not sure what we're dealing with here. NPH is a syndrome characterized by
a triad of symptoms: dementia, gait difficulties and urinary incontinence.
Typical CT scans show large ventricles and the patient will improve symptomatically
with a lumbar puncture for 30-40cc of spinal fluid. At the Cleveland Clinic
we usually do some more sophisticated neuropsychological tests as well as gait
testing to evaluate whether patients improve with CSF drainage. If certain
criteria are met, the patient may be considered for a shunt.

You describe your father as having burr holes drilled in the past for drainage
of some collection. Usually burr holes are done in elderly people for subdural
hematomas. It is conceivable that your father had a hygroma or some other
collection of CSF on the surface of his brain. If this is the case, it still
isn't clear why the permanent spinal shunt was placed.

Speak to your father's surgeon for some clear answers as to what is going
on. Simply put, the story doesn't quite add up. If you cannot find acceptable
answers, get a second opinion.

Good luck.
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