Little-Known & Treatable Brain Condition Mimics Alzheimer's

PITTSBURGH (KDKA) – Doctors say thousands of patients have been misdiagnosed with Parkinson's disease, or Alzheimer's when they actually have a very treatable condition.

It's called Normopressure Hydrocephalus, or NPH.

Under normal circumstances, fluid circulates through the brain, comes to the surface and is eventually reabsorbed by the body. The brain's entire fluid volume is turned over every 6-7 hours.

If normal circulation is blocked, pressure will build up in the brain as excess fluid accumulates. But, with NPH, instead of increasing pressure, the excess fluid causes ventricles in the brain to become enlarged; the pressure, however, remains normal.

"The way the brain is constructed…the fibers that are affected are the fibers that enable people to walk," says Dr. Jody Leonardo, who works in the Neurosurgery Department at Allegheny General Hospital.

The enlargement of the ventricles can also affect people's ability to control their urine, as well as their ability to be involved and engaged in everyday activities.

Local patient Helen Wiley, of Fombell, Beaver County, had most of the symptoms of NPH. She was having trouble walking, remembering things, and she had urinary incontinence. She was originally diagnosed with Parkinson's disease, and put on medication to treat that condition.

But it turned out, she actually had NPH.

Suspected NPH patients are preliminarily diagnosed using a CT scan or an MRI. Both scans will show enlarged ventricles if they are present. But, to make a true diagnosis, doctors need to perform a high-volume spinal tap. The procedure involves removing about 1/10 of the patient's spinal fluid.

"By draining a large volume of fluid, the patient's symptoms can be reversed," says Dr. Leonardo. "You can see right away a reversal in the actual symptoms."

Wiley also noticed that her ability to walk improved right away.

"When they [gave] me that spinal tap, I could walk for like three or four days, and then it went back to where it was before," says Wiley. "Boy, what a jolt… You expect it to last, and it didn't."

Unfortunately, the spinal tap procedure only offers temporary relief, but it does help doctors make a definitive diagnosis.

For a more permanent solution, Wiley was scheduled for surgery to treat NPH.

During the procedure, a shunt is placed in the swollen ventricle. A tube is then used to connect the shunt to the patient's abdomen, so the excess brain fluid can be drained and reabsorbed by the body.

There can be complications from the procedure. The brain can bleed if too much fluid is drained. But, to try to prevent that problem, a magnetically operated valve can adjust the flow.

There is also the potential that the tube which connects the brain to the abdomen can get blocked, so it has to be checked regularly. Doctors say once patients have surgery to treat NPH, they require frequent follow-ups as part of their long-term care.

Wiley's operation was a success. Her incontinence has subsided. She no longer uses a walker, or a cane.

"Boy, is that nice!" says Wiley.

She is still being monitored, but hopes she will be cleared to make plans with her family this summer.

"I hope I can go to the beach in June," says Wiley.

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