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Is it normal pressure hydrocephalus?

Normal pressure hydrocephalus, known as NPH, is a brain disorder that has three distinct symptoms, which usually come on gradually:

ªAn unsteady, almost penguin-like shuffle.

ª Loss of bladder control or frequent, sudden urges to urinate.

ªShort-term memory loss, an overall slowing of thought processes, difficulty paying attention, apathy, and change in personality and behavior.

Often a person with NPH may not have all three symptoms, but the unusual gait is typically the most common.

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Diagnosis includes a brain scan that reveals enlarged ventricles, which are hollow, fluid-filled chambers of the brain. That is typically followed by a lumbar drain trial in which a physician inserts a needle and catheter into a patient’s lower back and slowly drains large amounts of spinal and brain fluid over several days.

The patient’s ability to walk is measured before and during the lumbar trial to see if draining fluid improves the patient’s gait.

If symptoms improve, specialists say it is a sign that a patient would likely benefit from surgery to implant a shunt in the brain to continuously drain excess fluid.

Studies about long-term results from treatment have mixed conclusions, but suggest that walking ability is the first and most likely symptom to improve in patients who receive a shunt. Incontinence and cognitive problems are slower to improve, sometimes taking months, and may not totally resolve.

SOURCES: Brigham and Women’s Hospital; Alzheimer’s Association.

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.
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