Tuesday, January 28, 2014



 
  Water on the Brain
   
Idiopathic Normal Pressure Hydrocephalus (INPH) is an abnormality characterized by slow mobility, memory decline, urine incontinence, inattention, and brain ventricle enlargement. When it occurs due to brain trauma, stroke, meningitis, or unknown causes, it is “secondary” or “idiopathic.”

   Not all of these symptoms may be present in those affected. They are most common in people between sixty and eighty years of age.

   INPH affected people may have a broad-based (waddling) gait, with feet rotated outward and limited step height. Bladder incontinence and urinary frequency can be present in its early stages.
CT scanning shows brain ventricle enlargement.  

   Conditions that masquerade as INPH include nerve dysfunction (peripheral neuropathy), spinal cord narrowing, arthritis, and Parkinson's disease. 

   Treatment involves surgical diversion of spinal fluid. This is accomplished by implanting a shunt (catheter) that extends from the brain ventricles to the peritoneum (abdomen). The channeled fluid is directed to the abdomen veins, which direct fluid into the circulatory system. The procedure is done under general anesthesia and takes less than an hour. Surgical shunting is a straightforward procedure. It significantly improves symptoms in most patients. 

   Operative complications can include bleeding (intracerebral hematoma), improper catheter position, infection, and catheter obstruction.

  A review article (attached) showed that ninety percent of those who had this surgery noted improved mobility and walking.

   Patients with dementia and urinary incontinence before surgery were half as likely to improve.
Those who delayed surgery showed lower probability of a successful outcome. Following surgery, cognitive (brain function) was the slowest to improve.

   On the other hand, brain cognitive function improvement in more than fifty percent of patients who had the shunt surgery.



Famous quote: “Faith is taking the first step when you don’t see the whole staircase.” Martin Luther King Jr.