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Neurology (Expert Forum)
Normal Pressure Hydrocephalus
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Normal Pressure Hydrocephalus
by Susan, Aug 05, 2000 12:00AM
My father, aged 74, has been suffering from NPH for at least 6 years. His symptoms have been textbook: gait problems, short term memory loss and other cognitive problems, etc. Four years ago he had a shunt inserted. This alleviated the symptoms somewhat, for a brief period, but gradually they have worsened again. Currently they seem fairly severe to me. My father is now experiencing spells in which he loses complete control of his legs. On such occasions he has collapsed to the ground, or found it impossible to get out of bed. His hand control/coordination is so bad that he can no longer sign his name. Short term memory loss and problems reasoning are worsening. He has moments in which he 'spaces out' and clearly has no idea who or where he is.
Ever since the shunt was inserted he has been monitored on an ongoing basis by a variety of medical professionals (though not -- I think -- the specialist who inserted the shunt). Despite his persistent decline, they have continued to give him a clean bill of health until recently. As of a week ago, his GP indicated that a check-up with the specialist who inserted the shunt is in order.
I would very much appreciate any information you could provide to help my family formulate questions to ask the specialist.I have found all sorts of valuable information about NPH on the Internet (including messages on this site), so I think I have some idea about its causes, symptoms, treatment, etc., but I haven't found much about what to expect once a patient has received treatment. What is the long-term prognosis for NPH patients who have had a shunt inserted? So far, the family has assumed that my father's rapid deterioration is inevitable, but I am starting to question this. What is the rate of shunt failure? I understand that there are a variety of shunts, is any particular type more helpful to NPH patients (eg a programable shunt)? What sorts of tests are recommended for post-surgery NPH patients? MRI? Something else? Should the specialist be searching for additional problems? Are there any other common underlying causes of textbook NPH symptoms?
I apologise for the barrage of questions, but I understand that multiple postings to this site are expensive and drain valuable resources, so I've tried to cover everything in this one message!
Thanking you in anticipation for any feedback you can provide,
Susan
Ever since the shunt was inserted he has been monitored on an ongoing basis by a variety of medical professionals (though not -- I think -- the specialist who inserted the shunt). Despite his persistent decline, they have continued to give him a clean bill of health until recently. As of a week ago, his GP indicated that a check-up with the specialist who inserted the shunt is in order.
I would very much appreciate any information you could provide to help my family formulate questions to ask the specialist.I have found all sorts of valuable information about NPH on the Internet (including messages on this site), so I think I have some idea about its causes, symptoms, treatment, etc., but I haven't found much about what to expect once a patient has received treatment. What is the long-term prognosis for NPH patients who have had a shunt inserted? So far, the family has assumed that my father's rapid deterioration is inevitable, but I am starting to question this. What is the rate of shunt failure? I understand that there are a variety of shunts, is any particular type more helpful to NPH patients (eg a programable shunt)? What sorts of tests are recommended for post-surgery NPH patients? MRI? Something else? Should the specialist be searching for additional problems? Are there any other common underlying causes of textbook NPH symptoms?
I apologise for the barrage of questions, but I understand that multiple postings to this site are expensive and drain valuable resources, so I've tried to cover everything in this one message!
Thanking you in anticipation for any feedback you can provide,
Susan
Doctor's Answer
by CCF Neuro[P] MD, RPS, Aug 06, 2000 12:00AM
Dear Susan:
Sorry to hear about your father. I think that there are two basic camps in the diagnosis of NPH, those that believe that it is a true entity and those who think it doesn't really exist outside symptoms caused by a variety of etiologies. I think it does exist as an entity (for what ever that is worth). The increased ICP-like signs found in NPH seem to be reversible by lumbar puncture or shunting (as you have likely seen in your father). The problem is the continued lapses with LP and the inherit problems with shunts (e.g. failure). My first response is shunt failure with your father, and I would try and see if this is what is going on. One can follow ventricular size by CT scan and progression of disease by symptoms. We hope that by using these two entities that we can monitor a particular patient. So, my first suggestion is to make sure the shunt is working properly. Shunts can and do fail (sometimes very frequently, depending on the surgeon). Unfortunately, there is no one best type for NPH. Another thing that you should be aware of and watch for is the presence of a subdural hematoma. As we age our brain shrinks (in some it occurs very early, I have often meet these individuals at the license bureau and bank teller windows) the small veins that bridge the outside of the brain and the brain can rupture on there own, with little trauma noted. When they rupture they cause a bleed and hematoma. This too can cause mental status and neurological changes.
As you mentioned, symptoms of memory lapses, gait problems, bladder control, eye movement problems are all symptoms of NPH.
I hope I answered some of your questions. Take your father to a neurologist and have him checked out.
Sincerely,
CCF Neuro MD
Sorry to hear about your father. I think that there are two basic camps in the diagnosis of NPH, those that believe that it is a true entity and those who think it doesn't really exist outside symptoms caused by a variety of etiologies. I think it does exist as an entity (for what ever that is worth). The increased ICP-like signs found in NPH seem to be reversible by lumbar puncture or shunting (as you have likely seen in your father). The problem is the continued lapses with LP and the inherit problems with shunts (e.g. failure). My first response is shunt failure with your father, and I would try and see if this is what is going on. One can follow ventricular size by CT scan and progression of disease by symptoms. We hope that by using these two entities that we can monitor a particular patient. So, my first suggestion is to make sure the shunt is working properly. Shunts can and do fail (sometimes very frequently, depending on the surgeon). Unfortunately, there is no one best type for NPH. Another thing that you should be aware of and watch for is the presence of a subdural hematoma. As we age our brain shrinks (in some it occurs very early, I have often meet these individuals at the license bureau and bank teller windows) the small veins that bridge the outside of the brain and the brain can rupture on there own, with little trauma noted. When they rupture they cause a bleed and hematoma. This too can cause mental status and neurological changes.
As you mentioned, symptoms of memory lapses, gait problems, bladder control, eye movement problems are all symptoms of NPH.
I hope I answered some of your questions. Take your father to a neurologist and have him checked out.
Sincerely,
CCF Neuro MD
Member Comments (1)
by beebee35123, Jun 25, 2008 12:52PM
A related discussion, whats this shunt doing? was started.
