On last night’s episode, Izzie Stevens brings her former biology teacher to Seattle Grace (+Mercy West) hospital as he has been having memory problems. Turns out her teacher has a condition called NPH, which we will cover today.
Danger Level: High
What is it?
Normal Pressure Hydrocephalus (NPH) is a condition in which there is excess “brain fluid” inside the brain.
Who gets it?
NPH usually occurs in elderly people (usually over 60). It can happen to men and women alike.
What causes it?
Our brain and our spinal cord are connected to each other. They are both a part of our central nervous system. It doesn’t take a doctor to know that damage to them can lead to severe consequences.
To prevent damage to them, they are protected by fluid which floats around them, cushioning them. This fluid also provides them with nutrients and gets rid of waste products they produce. This fluid is called CSF – or cerebrospinal fluid.
This fluid is produced within our brain and circulates inside the brain and along our spinal cord.
The CSF is produced inside the brain and protects the brain and spine.
Our brain isn’t a solid structure. It has “holes” in it, called ventricles. Inside them there is an area called choroid plexus, in which the CSF is produced.
Normally, CSF circulates in the ventricles and on to the spinal cord and when an excess is produced it is absorbed. In NPH the system which drains and absorbs extra CSF doesn’t work like it should and there is too much CSF inside the ventricles. This causes the ventricles to enlarge and press on different parts of the brain, causing the pressure inside our skull.
NPH can be caused because of a head injury, bleeding around the brain, stroke, meningitis, or a brain tumor.
How does it feel?
NPH normally causes three major things:
1. Dementia: This is a decline in our mental abilities, meaning our ability to remember things, solve problems, concentrate and so on. It is the same thing that’s seen in people with Alzheimer’s disease.
2. Urinary incontinence: This is an inability to hold urine.
3. Abnormal gait: This means difficulty walking.
Other things which can be seen in NPH are headaches, nausea and difficulty focusing the eyes.
How is it discovered?
NPH can sometimes, but not always, be seen on CT scans or MRI scans. In them the brain’s ventricles might look bigger than normal.
A better way to diagnose NPH is to perform a spinal tap (or lumbar puncture) – in it a syringe is inserted to an area around the spinal cord and CSF is removed. This fluid is than analyzed for possible abnormalities. The interesting thing about this procedure is that when fluid is removed, the pressure on the brain subsides, making the symptoms go away.
How is it treated?
If the cause (such as a brain tumor) for NPH is known, a surgery to correct the problem is performed.
If it isn’t (which happens in many cases) a shunt operation is performed. In it, a tube is implanted in the brain’s ventricles, and travels under the skin to the belly, to where the fluid is drained.
What happens after treatment?
The shunt operation should relieve future pressure from the brain and prevent recurrence of the symptoms. Without treatment, symptoms often get worse and could lead to death.
It’s important to note that surgical treatment improves symptoms in about 50% of cases.
The bottom line – How do I avoid it?
Treating disorders that may lead to NPH (such as a brain tumor or a stroke) may prevent it from developing.
This video sums it all up:
What next?
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