Even though you can’t feel the blood circulating throughout your body, you know it’s there. What you might not be aware of, though, is another important fluid that flows through your central nervous system.
This clear, colorless fluid is cerebrospinal fluid, or CSF. CSF not only supplies nutrients to and removes waste from your central nervous system, which includes the brain and spinal cord, but also provides an important layer of protection to these parts of your body.
When CSF circulates as it should, you likely won’t notice it, but if starts to build up in excess within the cavities of the brain, called ventricles, the ventricles will become enlarged.
This abnormal buildup of CSF in the ventricles is called hydrocephalus (in Greek, “hydro” means water and “cephalus” means “head”). Sometimes the enlarged ventricles will increase pressure in the brain and lead to other conditions; this kind of hydrocephalus is often discovered at birth or can be caused by a neurological condition or trauma.
Sometimes, however, hydrocephalus doesn’t increase pressure in the brain. In this case, it’s known as normal pressure hydrocephalus, or NPH.
Causes of Normal Pressure Hydrocephalus (NPH)
Unlike other versions of hydrocephalus, NPH is more common in adults older than 60, and many cases have no known cause. When there’s no identifiable cause, the condition is known as primary NPH. When there is a known cause, the condition is known as secondary NPH. Secondary NPH can result from medical conditions including:
- Head injury (trauma)
- Infection, such as meningitis
- Bleeding in the brain (subarachnoid hemorrhage)
- Complications after brain surgery
Symptoms of Normal Pressure Hydrocephalus (NPH)
Even though NPH doesn’t increase pressure in the brain, it can still create several noticeable symptoms, including:
- Mental impairment and dementia — A patient may start to lose interest in daily activities or have changes in mood, memory loss, confusion, trouble focusing, or depression.
- Difficulty walking — The patient might feel “stuck,” or will shuffle while walking, which also puts the patient at risk for falling.
- A loss of bladder control — This could include the inability to hold urine (incontinence), a constant feeling of the need to urinate, or frequent urination.
- Seizures — If left untreated, NPH will worsen and can cause seizures that can also get progressively worse.
Diagnosis of Normal Pressure Hydrocephalus (NPH)
It’s important for NPH to be properly diagnosed, especially because its symptoms resemble those of other conditions often affecting the aged population, such as Alzheimer’s disease or Parkinson’s disease. In addition, NPH will become worse if untreated.
Diagnosis will usually include a neurological exam to determine whether brain function and walking have been affected, as well as tests to see what the inside of the brain looks like. These tests could include:
- Imaging tests such as a CT scan (using X-rays) or MRI (using magnetic fields and radio frequency pulses) to see the inside of your head to check whether the ventricles are enlarged
- A spinal tap (known as a lumbar puncture), where a thin needle is inserted into the lower back to collect CSF for testing
Treatment of Normal Pressure Hydrocephalus (NPH)
There is no known cure for NPH, but treatment can relieve symptoms — which is important because if left untreated, the symptoms of NPH will get worse and could cause death.
Treatment of NPH could include surgery that inserts a shunt, which acts as a drainage system to remove excess CSF. One end of the shunt — a long, flexible plastic tube — is placed into one of the ventricles, and the rest of the tube runs under the skin to another part of the body (usually the abdomen), where CSF can be reabsorbed by the body. The shunt contains a valve to regulate pressure.
The shunt procedure doesn’t work for every NPH patient. A spinal tap diagnosis can determine whether the patient is a good candidate for a shunt.
Another procedure to treat NPH by draining excess CSF is called endoscopic third ventriculostomy. This is surgery that uses an endoscope (a thin tube with a lighted camera on one end) to create a small hole in the floor of the ventricles. The procedure is named for the area where it takes place; the blockage is usually located in the narrow pathway between the third and fourth ventricles of the brain
Make an Appointment with Dr. Woodall Today
Brain conditions such as normal pressure hydrocephalus (NPH) require expert diagnosis and treatment. Dr. Woodall has the training and experience to provide the comprehensive, patient-centered care you can trust. Contact our office today.