Normal Pressure Hydrocephalus, or N.P.H. is so often missed or misdiagnosed. According to Dr. Mark Luciano, a neurosurgeon at the Cleveland Clinic, 50,000 to 375,000 people in the United States, with the higher figure more likely to be correct suffer from N.P.H.
“There are a lot of people out there with a correctable problem that is attributed to old age,” Dr. Luciano said. “When the problem is fixed, it’s like rescuing them from oblivion. A small percentage of people with dementia — maybe 10 or 15 percent — really have N.P.H.”
The disorder was recognized and named in 1965. But most doctors who treat older people are either completely unaware of the condition or fail to consider it when treating patients with classic, albeit confusing, symptoms.
The disorder involves a build-up of spinal fluid in the ventricles of the brain, causing pressure on nerves that control the legs, balance, bladder and cognitive function. “It’s as if the brain has reverted to babyhood,” Dr. Michael Kaplitt, a neurosurgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, said in an interview. “Like babies, people with N.P.H. walk slowly with feet wide apart, they are incontinent and have no memory.”
In most cases, the cause of N.P.H. is unknown. For some patients, the cause may be a severe head injury, stroke, meningitis or a brain tumor, perhaps decades earlier, which may have caused scarring or inflammation that gradually interfered with drainage of spinal fluid.
Normal pressure hydrocephalus is best diagnosed by a team that includes a radiologist, neuropsychologist and neurologist or neurosurgeon experienced in distinguishing this condition.
Although there is no one route to diagnosis, if N.P.H. is suspected, a CT scan or M.R.I. of the brain can reveal one or more enlarged ventricles, an essential feature of the condition. On an M.R.I., Dr. Kaplitt said, the spinal fluid often is cloudy or turbulent.
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