Normal Pressure Hydrocephalus \\ everything you need to know

Brought to you by Dr. John Edwards, neurosurgeon at Summit Brain and Spine, as part of the Summit Medical Institute

This video discusses everything you need to know about a normal pressure hydrocephalus (NPH). Including what it is, the symptoms, how it's diagnosed, and how to treat it

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0:00 intro
0:12 what is hydrocephalus
0:55 what is normal pressure hydrocephalus
1:15 NPH symptoms
2:02 how is NPH diagnosed
3:05 NPH treatment
4:11 summary

Transcript:
In this video I want to talk about a condition called normal pressure hydrocephalus.
So, first let's talk about what is hydrocephalus. In the brain. There are areas that are filled with spinal fluid called the ventricles. Spinal Fluid is made inside the ventricles. And then it circulates from within the brain to outside of the brain and it baits the surface of the brain and then it gets gets reabsorbed in the bloodstream. In some patients, there can be a buildup of that fluid and we call that hydrocephalus. Hydrocephalus can occur in little babies all the way until old age and it can be from a variety of different reasons. normal pressure Hydrocephalus is a unique type of hydrocephalus that occurs primarily in patients that are older and does not involve an increase in the pressure. It's just the size of the fluid spaces inside of the brain. What are the symptoms of normal pressure hydrocephalus? One symptom is what is called a magnetic gait. The patient walks with small steps, and they have a hard time picking their foot up off the floor, and it's almost like a shuffle. Another symptom is urinary incontinence. Now, patients in their older age may have incontinence for a variety of reasons. But in this case, patients could have incontinence from normal pressure hydrocephalus. And the final symptom is cognitive impairment. It's one of the potentially reversible forms of cognitive decline in an older population. So how has it worked up? How do we diagnose it? The first part of the diagnosis would be a history of physical and then to do usually a head CT or maybe an MRI, the head CT and the MRI which show the size and the shape of those fluids filled spaces or ventricles inside of the brain. If they're large, and they appear a certain way, then we presume that the patient might have normal pressure hydrocephalus. The next step is to drain spinal fluid and to test what the patient's symptoms are like before and after draining the spinal fluid. And that's done usually by a lumbar puncture. And typically a neurologist would help coordinate that. But that's one test to tell if the if the patient's symptoms are likely related to the buildup of fluid. How is normal pressure hydrocephalus treated? The most common treatment for normal normal pressure Hydrocephalus is called a VP shunt. And what that is, is a little catheter or tube is placed into that fluid filled space in the brain called the ventricle and then the catheter goes down under the skin and into the abdomen. And that allows the fluid or the excess fluid to drain away from the brain and then get reabsorbed inside of the belly. That's called a shunt and patients with normal pressure hydrocephalus may be good candidates for placement of a shunt. The symptoms that most frequently get better with a shunt are the patient's ability to walk and the urinary incontinence. Sometimes we see improvement in the cognition, but that is less common to improve. In summary, normal pressure Hydrocephalus is a type of condition or a type of hydrocephalus that can cause gait disturbance, or difficulty with walking, urinary incontinence and difficulty with memory in primarily older patients, and in some cases, patients can get relief of symptoms with a VP shunt