Normal Pressure Hydrocephalus, or PNH, is a situation characterized by the accumulation of cerebrospinal fluid (CSF) in the brain and enlargement of the cerebral ventricles due to excess fluid, which can lead to the appearance of three characteristic symptoms, which are difficulty walking, incontinence urinary and loss of cognitive functions.
PNH is more common in people over the age of 65, although it can happen at any age, and is completely reversible, that is, it is curable as long as it is quickly identified and treated. In most cases, treatment is done by draining the accumulated CSF and redirecting it to another location in the body to be reabsorbed.
Main symptoms
Despite the excess of fluid in the intracranial cavity, there is no increase in pressure, however there are the development of three typical symptoms, which are known as the PNH triad: difficulty walking, urinary incontinence and progressive loss of memory and cognitive functions. These symptoms can appear together or separately, do not follow a specific order and progress progressively. Other signs and symptoms that are indicative of PNH are:
- Decreased attention and concentration; Disorientation; Intellectual changes; Difficulty performing fine movements, such as picking up a pencil or pen, for example; Personality change; Obsessive Compulsive Disorder, OCD; Apathy, in which the person has no enthusiasm or motivation to carry out activities.
The symptoms of PNH can also be considered as typical manifestations of old age or as being indicative of dementia, Alzheimer's, Parkinson's or depression, for example. For this reason, it is important that when signs and symptoms of normal pressure hydrocephalus are identified, the person is referred to the neurologist for differential tests to be performed and, thus, treatment begins.
Thus, in order to conclude the diagnosis of normal pressure hydrocephalus, the doctor must request a computed tomography scan of the skull or magnetic resonance imaging so that the brain can be visualized, identifying the foci of fluid accumulation and the enlargement of the cerebral ventricles.
In addition, the Tap-Test can be performed, which is an exam used to verify whether the patient would have a positive evolution with surgical treatment. This examination consists of carrying out tests to assess the patient's symptoms, especially gait changes, and a lumbar puncture is performed to remove excess fluid. After three hours of the puncture, the symptom tests are performed again and if it is found that after 3 hours there is no worsening of the symptoms, it is a sign that the ventricles have not completely refilled and that the person has great chances of having positive results for through surgical treatment.
Causes of Normal Pressure Hydrocephalus
Normal pressure hydrocephalus can be classified as idiopathic, in which it is not known why there was an enlargement of the ventricles due to the production of CSF excessively, or secondary, which is when the disease happens as a consequence of another situation.
Thus, secondary PNH can happen as a consequence of changes during fetal development, traumatic brain injuries, strokes and infections in the nervous system, such as bacterial meningitis and mumps, for example.
How the treatment is done
The treatment of normal pressure hydrocephalus aims to decrease the symptoms of the disease by draining the CSF accumulated in the ventricles to another part of the body to be reabsorbed. In this way, it is possible to make the ventricle return to its normal size and the symptoms are relieved.
In addition, during the procedure the doctor can also circulate a medication in the brain in order to regulate the amount of CSF produced, preventing the accumulation from happening again. Understand how hydrocephalus treatment is done.
