Normal pressure hydrocephalus is a benign condition that affects people over 60 years of age. It causes symptoms that appear gradually, such as memory loss, urinary incontinence, and unsteadiness in walking. So, it affects three functions – memory, urination, and walking.
This symptomatology appears slowly and gradually, with the result that the patient does not focus on it for a long time. Sometimes, the patient, after a long period of time without proper treatment, ends up bedridden with minimal communication with the environment.
The cause of the disease is unknown, although various factors have been proposed for its creation. What happens in the brain of a patient with normal pressure hydrocephalus is this: the spaces that we all normally have in our brains called ventricles swell due to the disturbed circulation of the fluid they contain (cerebrospinal fluid-CSF). This swelling presses on sensitive structures of the brain, causing symptoms of dementia, loss of urine, and unsteadiness in walking.
Patients with normal pressure hydrocephalus can recover if diagnosed early and treated with neurosurgery.
Diagnosis requires a series of very careful steps. These are taking the history, the neurological examination, performing an MRI of the brain, videotaping the patient’s gait, and then removing cerebrospinal fluid from his spinal column (lumbar puncture) in order to see the improvement of his symptoms. In a few cases, the patient may have a spinal drain placed under local anesthesia to drain a large amount of fluid (300ml) over three days. This whole process of diagnosis is necessary because the symptoms of memory loss, urinary incontinence, and unsteadiness of walking are also present in other diseases, such as some dementias and ischemic leukoencephalopathy.
The treatment involves placing a small specialized synchronous device in the patient’s skull called a hydrocephalus valve. This through a long catheter removes fluid from the ventricles and directly into the patient’s abdomen where it is absorbed from the walls. It is a safe, short-term and serious operation with very good results.
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