Parkinson’s or Alzheimer’s: Mis-diagnosis?

NPH (normal pressure hydrocephalus), a treatable brain disease, is often diagnosed as something more sinister, such as Alzheimer’s, Parkinson’s or Dementia. This is great news for families dealing with the debilitating prognosis of Alzheimer’s and Parkinson’s but in order to receive proper treatment NPH must first be diagnosed.

Lesser-known and treated with much more success, NPH is difficult to diagnose in its early stages. Humans have water on the brain but with NPH an excessive amount of water builds up, around the brain, over a span of time. The pressure from the extra water squeezes the brain, stretching it in some places. Some early brain scans can detect the problem but many sufferers don’t seek a physician’s advice and simply try to live with it, thinking they’re just getting old.

Left undiagnosed NPH can mimic some of the signs of Alzheimer’s, Parkinson’s Disease or even dementia. Patients have trouble standing or walking and have trouble remembering important things. Many patients also experience loss of bladder control. The neurological disease can be treated, though, with some success if caught early enough. And, since most patients are elderly when NPH strikes it’s often mistaken, upon onset, for symptoms of aging.

Something drastic, such as the inability to walk at all, is often the deciding factor in contacting a physician. But, results prove that the longer the time before the diagnosis, the less likely the disease will be treated with great success. It’s important to catch NPH in its early stages with an MRI procedure. With MRI the image of the brain, and the surrounding water, are noticeable. The surgery can then be performed before the brain loses some functions because of the squeezing and stretching that occurs.

As treatment, a programmable shunt is positioned in the skull. The shunt allows excess water to drain from around the brain straight to the abdomen where it can be eventually disposed of. Although the surgery doesn’t work for everyone with NPH, for those who have success, recovery is fairly quick – with most patients being back to their old selves within weeks. A percentage of the successful patients will, however, see a decline in health again, in sometimes under a year. Other patients have no more NPH troubles and continue on with good health.

The most common and first seen symptom of NPH is usually problems with walking. From a mild imbalance when rising, to the inability to stand at all, to trouble picking up your feet to step up on a curb, these could all be symptoms of the onset of NPH. Frequent falling while walking is definitely a red flag. Other symptoms include loss of interest in daily activities, forgetfulness, difficulty in performing regular tasks, incontinence, urinary frequency, and in rare cases, loss of bowel control.

The diagnostic procedures used to decide if a patient is right for the shunt can include ultrasound, a CT scan, MRI, spinal tap, ICP monitoring, and neuropsychological testing. The actual surgery itself takes about an hour.

During the surgery an incision is made in the head and in the abdomen. The shunt is inserted in the brain and a tube passed, under the skin, to the abdomen. The patient is observed for a day or two following the surgery. Some surgeons opt to keep certain patients even longer. Total hospital stay can be up to seven days. After having NPH some loss of motor skills may have occurred and it is then recommended that the patient have physical therapy for a period of time.

There can be complications after the surgery. One such problem, in about fifty percent of the patients, develops when the shunt becomes clogged. The shunt can be clogged after months or even after a few hours. Symptoms can reappear suggesting that the shunt has become clogged. Shunt obstructions are fixed easily with the patient continuing to do fine following the un-clogging of the shunt.

The most serious problem that can occur after the insertion of the shunt is a blood clot. Symptoms include headache, paralysis, coma or death. Most blood clots related to the shunt occur after the patient has fallen and bumped the head. Even a slight bump should be immediately investigated by a qualified physician.

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