Normal pressure Hydrocephalus

[MaryH62]

I am a very healthy, slim and fit 62 year old woman. Nearly a year ago I was hospitalised with what was diagnosed as a very severe case of vestibular neuronitis. Following that (my neurologist says) many of the pathways in my brain shut down. I had to learn to walk, read, use a computer and oven and many other things. My memory is effected on many levels. I have returned to work parttime. I work as a mediator. I am still woozy and my memory, eyesight and writing play tricks on me. My walking is clumsy and unbalanced. My head is uncomfortable. Turning my head is still difficult.
Recently as a result of an MRI I have been shown to have NPH. With mild ischaemic changes, Hyperdynamic CSF flow (23.4mls/min) with slightly enlarged ventricles.
I have been referred for a neuropsyche assessment and to have another in 9 months time to assess degree of ongoing functional problems and then to weigh up the surgery options.
My neurologist consulted a couple of neurosurgeons before getting back to me about the MRI results. Some of the things she told me about the condition were not accurate as to the definition. She has also told me CSF testing is not appropriate and that surgery is to be avoided. May I have your opinion on options for the best way forward please?
Many thanks from NZ

[Shiv Kumar, MD]

Dear MaryH62,

Thanks for providing more details.

Except for the balance problems, I don't see any typical symptoms fitting in to the diagnosis of Normal Pressure Hydrocephalus.

Get your memory tested and see what kind of memory problems you have. Depending on the type of memory problems one can decide whether Normal Pressure Hydrocephalus is a possibility or not.

You can repeat MRI brain 3 months later with repeat neuropsyche Assessment. If there is a worsening, then get investigated or else just wait and see.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr Shiv Kumar R

[Shiv Kumar, MD]

Dear MaryH62,

Vestibular Neuronitis is a rare disease which presents with severe Vertigo, Vomiting and Imbalance in Walking. Most of the times it recovers completely without any permanent deficits within one week. A minority have recurrent vertiginous episodes following rapid head movement for years after onset. This does not cause memory problems. It does not shut down any pathways in the brain. So I feel the problem was not purely Vestibular Neuronitis but something more than that.

Incidentally, Normal Pressure Hydrocephalus has been diagnosed on the MRI of the Brain. Normal Pressure Hydrocephalus presents with memory problems, gait problems and in the later stages urinary incontinence. But your clinical profile does not entirely fit in to the diagnosis of Normal Pressure Hydrocephalus.

Get your Neuropsyche assessment done which will act as baseline reference for the future. Normal Pressure Hydrocephalus has characteristic deficits. Repeat it after 6 months and compare it to the previous report. If there is worsening of memory and gait problems you may require repeat MRI followed by tap test where CSF pressure is measured and 20-30 ml of the fluid will be removed for examination.

After removal, memory and gait is tested again. If there is significant improvement in both the parameters then surgery is advised.

So before I conclude I would like to know few more things:
1. Was there any memory problems before you had problems of Vestibular Neuronitis?
2. Do you have gait problems like walking with short steps as if the feet are stuck to the ground?
3. Do you have urinary problems like urgency or incontinence?
4. Is there any history of head injury in the past?
5. Any similar symptoms present in any of your family members?

Please let me know the above details for me to conclude.

Awaiting your response.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefited from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr Shiv Kumar R

[MaryH62]

1. Was there any memory problems before you had problems of Vestibular Neuronitis? No
2. Do you have gait problems like walking with short steps as if the feet are stuck to the ground? Yes, but they seem more balance related
3. Do you have urinary problems like urgency or incontinence? No
4. Is there any history of head injury in the past? Yes, relatively minor over 15 years ago. Cracked the bone under my left eyebrow. No treatment. No concussion. Subsequent weeping of left tear duct at times.
5. Any similar symptoms present in any of your family members? No