Dementia or progressive memory loss in the elderly is a dreaded disease. Therefore, it is imperative to rule out all treatableor reversible causes of dementia. NPH or Normal Pressure Hydrocephalus is the commonest Treatableor Reversible cause of Dementia.
Hakims or NPH Triad
NPH is a progressive disease. This means that all cases of dementia especially with additional features such as above should be investigated to diagnose Treatable NPH so that it is treated on time.
Normal Pressure Hydrocephalus denotes an excess of Cerebrospinal Fluid (hydro-water) in the brain (cephalus) with no increase in intracranial pressure.
MRI can be suggestive of NPH but not conclusive.
Improvement of symptoms to Lumbar Puncture drainage of Cerebrospinal Fluid (CSF) is Definitely Diagnostic of NPH.
However, lack of improvement does not discard the possibility of NPH. In a clinically likely scenario with a highly suggestive MRI, a chance at surgery may be taken after appropriate consent from the family.
Surgery is the only effective option.
The preferred surgical method is placement of a Programmable Shunt.
Surgery involves placement of a tube in the CSF containing ventricles of the brain through a small incision which is in turn connected to a valve underneath the scalp (skin of the skull) from which another draining tube is tunneled under the skin to the abdomen where the tube is inserted into the abdominal cavity through another small incision. Therefore, only two small incisions are required, one in the scalp and one over the abdomen. The tube therefore shunts CSF from the brain to the abdominal cavity via a flow-controlling valve.
The less-expensive valves are fixed-pressure valves which means that if the chosen pressure is not appropriate for the patient, re-surgery will be required to change the valve.
The preferred valve is a Programmable Valve, the pressure of which can be adjusted externally thus tailoring the pressure to the exact level required for the patient.
An aggressive exercise/physiotherapy regimen is crucial to maximizing recovery post-operatively and needs to start from post-operative day 1.
Valve programming may be required depending on clinical outcome and post-operative CT scan.
Postoperative recovery-Miraculous improvement
Post-operative recovery is quite miraculous in patients, especially among those who improve at least partially following a pre-operative Lumbar Puncture drainage of CSF. Recovery happens over weeks/months and is maximized by an aggressive exercise/physiotherapy regimen. In view of the miraculous improvement which is often witnessed following this surgery, surgery for NPH is one of the most gratifying brain surgeries.
Postoperative recovery- Miraculous improvement
Post-operative recovery is quite miraculous in patients, especially among those who improve at least partially following a pre-operative Lumbar Puncture drainage of CSF. Recovery happens over weeks/months and is maximized by an aggressive exercise/physiotherapy regimen. In view of the miraculous improvement which is often witnessed following this surgery, surgery for NPH is one of the most gratifying brain surgeries.
