What is normal pressure hydrocephalus?
Do you know anything about normal hypertrophic hypertension?
Do you know the symptoms of normal hypertensive hydrocephalus (NPH)?
In this article, you will learn more about NPH.
In this disorder, the fluid that surrounds the brain and spinal cord, which doctors call cerebrospinal fluid (CSF), becomes excessive and puts pressure on the soft tissues of the brain and spinal cord, It is said that although the amount of fluid around the brain has increased, the pressure inside the spine is normal and does not increase.
Hydrocephaly consists of two components: hydro meaning water and cephaly meaning head.
Now you know what the term “normal pressure hydrocephaly” is
By increasing the volume of cerebrospinal fluid around the brain, this fluid with pressure on the soft tissue of the brain causes injuries that will cause different symptoms in the patient depending on the extent and area of damage.
Parts of the brain called the ventricles of the brain are said to increase in size.
Doctors say that parts of the soft tissue of the brain that are under pressure with increased cerebrospinal fluid will be related to the function of the organs and the following areas:
- Sections related to memory
- Cognitive processes in the brain such as reasoning power, problem solving ability
- Sections related to speech
In many cases, unfortunately, physicians may confuse cognitive impairment of NPH with Alzheimer’s disease, or movement disorders of the legs in NPH with Parkinson’s. The very important point is that the correct diagnosis must be made.
What is cerebrospinal fluid?
It is said that in parts of the brain called the ventricles of the brain, a fluid is produced that covers the soft tissues of the brain and spinal cord. This fluid is called CSF.
CSF tasks include:
- Care of soft tissues inside the skull and spine.
- Delivery of nutrients to the tissues of the brain and spinal cord
- Removal of toxic and waste compounds from the brain and spinal cord
Excess fluid is said to be reabsorbed by the arteries and vessels above the brain to prevent fluid buildup.
If too much fluid is produced in the ventricles of the brain and for any reason the vascular reabsorption system is not efficient, the ventricles of the brain enlarge to accommodate the excess fluid and hydrocephalus develops.
The causes of hydrocephalus are varied:
NPH is a type of hydrocephalus that affects most people over the age of 60 and spreads slowly.
Patients will gradually and slowly develop disorders in the CFS discharge process.
As the disorder progresses, the ventricles of the brain gradually increase in size and the fluid pressure does not rise to the level of other hydrocephalus and remains within a relatively normal range, while in other types of hydrocephalus there is a very large increase in intracranial pressure. The term normal pressure should not be taken to mean that there will be no pressure on the soft tissue of the brain
Causes of NPH
The following causes can cause NPH:
- Trauma to the skull
- Cerebral hemorrhages
- Brain tumor
- Brain infections
- Complications of cranial surgeries
Of course, it is not yet clear exactly what the cause is.
What are the symptoms of NPH?
- Memory loss
- Cognitive disorders such as difficulty in judgment and reduced decision-making power
- Problem in the power of reasoning
- Difficulty concentrating
- Changes in mood
- Indifference to events and circumstances
- Difficulties in speech and change of speech
- Walking problems
- Weakness in the legs
- Sudden falls
- The steps of the infected person become unstable and cross-shaped
- The person feels that his legs are locked while walking.
- It will be difficult to take the first step at the beginning of the movement
- Urinary symptoms:
- Inability to control urination
- Frequent urination
- Urgent need to urinate
- Urinary incontinence
- In rare cases fecal incontinence
In summary, there are three categories of symptoms in NPH:
- Gait abnormality
- Urinary incontinence
Following the increased accumulation of cerebrospinal fluid in the skull, there are also the following manifestations:
- Blurred vision
What do doctors do to diagnose NPH?
If your loved ones have a combination of symptoms of Gait abnormality, dementia, memory loss and urinary problems, you should definitely take them to a specialist for specialized examinations.
It is common for Parkinson’s to be diagnosed with Gait abnormality and for Alzheimer’s disease with memory and cognitive problems. Obtaining an accurate and intelligent history or questions and answers in older people, examining physical symptoms and observing how a person walks, a list of medications used along with cognitive tests that are used to assess mental strength and skills and some tests for neurological disorders will be required in the diagnostic process.
There is no specific laboratory test for NPH diagnosis
Tests will only be requested to assess possible underlying causes.
The following imaging is used to study and evaluate intracranial fibers:
- CT scan of the brain:
It cannot detect NPH, but the size of the ventricles of the brain can be determined by CT scan.
A CT scan alone will not be enough to make a diagnosis
- MRI of the brain:
MRI alone will not be able to confirm NPH
In this method, the absorption of cerebrospinal fluid is examined
- Extraction of cerebrospinal fluid from the lumbar or lumbar puncture, (LP):
The doctor removes the cerebrospinal fluid (CSF) from the space between the patient’s lumbar vertebrae with a special needle and instrument. During this process, the pressure of the fluid column is measured and the fluid and the cells in it are carefully examined.
Cerebrospinal fluid analysis may provide clues to underlying causes
If the patient’s symptoms decrease following LP, it is a sign that the patient will respond better to implantation of surgical shunts.
NPH is a long-term complication of brain injury and there is no cure for NPH, but most patients with surgical shunts will have a relative improvement, meaning that surgical shunts are not a definitive treatment and only have a calmative role.
Behavioral problems due to mood swings and dementia as well as urinary symptoms should be managed by appropriate physicians so that the sufferer can have a good family and social life.
Normal hypertrophic shunt surgery
Shunt surgery or endoscopic surgery of the third ventricle of the brain are among the calmative treatments for this category.
The shunt is a thin tube that is inserted into the ventricles of the brain. This is done by neurosurgeons. This tube will carry the cerebrospinal fluid produced in the ventricles to another area of the body, such as the abdominal cavity. This tube travels under the skin.
Shunts have a valve that transports fluid to the abdomen or peritonitis when CSF secretion increases, where excess fluid will be absorbed by the bloodstream.
In some NPH cases, serial shunt implantation is not effective, but it is said that if the patient has reduced symptoms with LP, the shunt will most likely work for him.
Finally, the sooner NPH is diagnosed, the better the chances of shunt surgery being effective.