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
Please like and subscribe for more up-to-date, patient oriented medical information posted weekly!
Follow our Instagram @summitbrainandspine / summitbrainandspine
Check out our website www.summitbrainandspine.com/
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

[@otmanezogdani]

Great Explanation, Thank you.

[@hairballjones8451]

Trying to learn the difference between Idiopathic Intercranial Hypertension and Normal Pressure Hydrocephalus 🤔- I am within right age spectrum for one but my consulting neurosurgeon is leaning toward IIH of long-standing duration. Perhaps this is why doctors and surgeons say they " Practice " for they still are learning too. Frightening isn't it for we lay- women and men also? So I am learning as I go always!

[@tarheelfans98]

My husband is 48. In Dec had an MRI for headaches and memory loss. They did find enlarged ventricles. Was sent to a neurologist and that lead to an LP. He had amazing results after the LP. Referred to neurosurgeon. By now he is noticing some changes but not too bad. Shunt surgery is in June. In the last few weeks I’ve noticed his cognitive abilities have been more impaired. I’m nervous for the surgery but I’m so hopeful he will start to feel better. I’ve joined a support group on FB as well.

[@MrJamey1974]

Pray that your husband has a successful surgery . I had this procedure done the first part of April of this year . I’m still recovering,

[@angierains8413]

Excellent video

[@summitmedicalinstitute]

Glad you liked it

[@popgoestheweasel95]

I had all those symptoms he mentioned, and at 69 had the NPH surgery which has worked like magic. I was about ready to jump off and I am practically brand new just a year and a half later a few headaches, but nothing major compared to before. JustMyThoughts 🙄🙄

[@tarheelfans98]

That’s so great to hear! I’m glad it’s been so helpful. My husband is 48 and will have a shunt placed for his NPH in June. I’m really hopeful it will really help him feel more like his old self. He had a great result after his lumbar puncture. Hope you’re well. Thank you for sharing. It makes me feel a bit better when I read comments like yours.

[@PaulsWanderings]

I have congenital hydrocephalus. I have been lucky as I have only had 3 shunts and I am 53. It is possible to "outgrow" hydrocephalus or the need for a shunt. I ask as during some x-rays for an unrelated issue, it was discovered the my catheter is all broken up and was referred to a neurosurgeon who looked at the x-rays and past CT scans, we don't trust an MRI as we don't know if my shunt has any metal so I only do CT scans. My current shunt was installed around '76 or '77. I am not looking for a medical diagnosis but information. I haven't had any issues with my shunt since it was put in. I have just haven't heard of anyone "outgrowing" the need for a shunt.

[@summitmedicalinstitute]

Thank you for your comment. It's not that a person will "outgrow" the need for a shunt, but rather more often we will see that the shunt becomes less effective and thus patient may elect to stop using them or have them removed.

[@trevorcallow8132]

Hi all my name is trev i Have Hydrocephalus and i must be one of the lucky one my shunt doz not work i saw 9 years young and it stoped i am 63years young now and no trable

[@mehtabzaidi951]

You have explained it so well. Thanks

[@summitmedicalinstitute]

I'm glad you found it helpful. Thank you for watching.

[@leebee2268]

I was diagnosed with hydrocephalus on an incidental MRI that showed I had very large ventricles, 30 years ago. I had forgotten all about it and not given too much thought. I am now 58 years old and noticing some symptoms that go along with NPH. Is it possible to sit on it for that long and then slowly develop symptoms as I am the age that I am. I have been dealing with incontinence, balance, and having a heavy feeling when I walk (stiffness). I have no headaches. Is this a normal progression? I don’t have a good insurance at this time so I’m a bit nervous that I will need a work up.

[@Paul-hu1ht]

I have been fighting for 2 years to finally get our hospital/consultant to test for and agree that our father has NPH (he's 82) - I'm not sure how serious your symptoms are currently, but if you are experiencing a gait when walking (shuffling/heavy to pick up feet resulting in many more steps being taken/falling over), alzheimers and dementia symptoms (which leads to urinary incontinence and eventually falls) then you need to go back and see your consultant before it gets worse. The incontinence occurs because the NPH prevents your brain from telling you/your body that you need to go to toilet (until it's too late). They can perform a lumbar puncture to drain some fluid from your spine and measure the distance/time you walk before/after to see if a positive effect occurs and whether a shunt is needed (sometimes a yearly drain can be a solution, but if symptoms worsen after 1-2 weeks of the LP, then a shunt is likely needed). Best of luck!

[@KiKiQuiQuiKiKi]

(These doctors never bother responding to their own videos). You want to stay ahead of the symptoms because sometimes they’re irreversible or only partially reversible.

[@tarheelfans98]

I agree you hardly ever get a reply. IMHO, yes it could be possible. My husband is having a shunt put in, in June. If you have Facebook. There’s a wonderful NPH group. I’ve learned a lot and they can help guide you on what to do. I would suggest, let your PCM know about that prior enlarged ventricles and the symptoms you are having. Apparently NPH is often missed because many symptoms can be attributed to other things. Like simply getting older. I wish you all the best!

[@tarheelfans98]

Just wanted to share. On June 12,2024 my husband had his shunt placed. He had a lot of head pain but was released 2 days later. He’s doing okay but not as well as I had hoped. Not sure if we may have over/under draining going on. He does get head pain after being up for several hours. I’ve seen this can signal over draining. If it gets better when lying down. However, his walk has not returned the way it did literally 2.5hrs after his LP. So I thought maybe it wasn’t draining enough. He doesn’t even have his stitches out yet. I know it’s early in the recovery but I just feel like something is slightly off. I don’t know if it warrants a call to his NS or not. Any advice?

[@summitmedicalinstitute]

It may take some time to get the correct setting on the shunt, so I would advise close follow up and communication with your provider. Thank you for your comment.

[@kissy1276]

My dad just got diagnosed with that but the thing is... He could die anyway if he has surgery😢 He has to be on blood thinner but they will have to stop that which can cause a major stroke...ugh its s messed up situation 😢

[@tarheelfans98]

I’m very sorry. Not sure where you guys are with this. Do you have an update on your dad? How is he doing? I’m scared to ask. 😞

[@kassandrad6540]

Saying a prayer for your father and for your family. If he is still with us, Lord put your hands of healing on this person’s father, and show their family that they have the strength and love abound. Please guide them through this, Lord. In Jesus name. Amen. 🙏

[@georgehyde3741]

I think nph is killing me. Today i have been incontinent

[@anjanikumar5227]

My baby has been diagnosed with hydrocephalus & has been delivered prematured (25 days before delivery date). Is being treated using Omaya with daily taping requirement. Since last 15 days there is no requirement of taping. What can we conclude... require your suggestion.. Regards

[@summitmedicalinstitute]

Thank you for your question. A complete review of the patient case would be needed to give accurate advice on treatment and prognosis. I would recommend communicating with the treating provider.

[@user-nj8sh7sd6w]

My husband is 48 and he has his vp shunt fix on the 16th of march 2024 since he is doing well is just sometime he feel little headache

[@summitmedicalinstitute]

I'm happy to hear that. Thank you for sharing.

[@keironneb-n1261]

If no gait or incontinence issues are seen, and the lumbar puncture had only slight improvement on cognition, would you implant shunt? 77 year old patient.

[@capresti3537]

No, there has to be a dramatic improvement to proceed with the shunt.

[@Elijahgavi]

@@capresti3537yo what if she has walking issues but nothing changed when she got a lumbar puncture should she get a shunt ????

[@capresti3537]

@@Elijahgavi No because there is no benefit.

[@mrjp6255]

Your voice is similar to that of sheikh Hamza yusuf!!

[@peachmelba9333]

Well they say everyone has a double somewhere in the world- maybe this presenter is a vocal/ speech pattern double to the person you're citing.

[@jaenokhiria6693]

I thank #Dr Ofenmu on KZbin for your perfect and honest work. You were able to restore my health and sex life with the help of your Roots Herbs. I pray that God will give you more wisdom to continue your perfect works to help others as you have helped me.