Normal Pressure Hydrocephalus: A Specialized Program and Greater Hope

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Right now. This minute. And at every second. There is an important flow of specialized fluid produced by your brain that regulates the healthy function of your body's neurological system.
We're talking about cerebrospinal fluid (CSF), which flows throughout the brain and spines small spaces. CSF plays a vital role in protecting your Central Nervous System (CNS), in brain development, and in regulating brain function.
In health, CSF is produced and absorbed at a variable rate to maintain a specific pressure. But sometimes, this process goes awry, creating a buildup of fluid that can put too much pressure on parts of the brain and cause serious health problems. This occurs with a disorder called Normal Pressure Hydrocephalus (NPH).
Because the symptoms are often masked by the normal aging process, NPH is more difficult to diagnose and often goes untreated. In fact, NPH is sometimes confused with Parkinson's disease or Alzheimer's disease. This is what led AdventHealth to develop an NPH program, the only one of its kind in Central Florida and one of only 10 throughout Florida.
AdventHealth has developed a specific protocol for diagnosing and treating NPH, which is unique, says Donald Behrmann, MD, neurosurgeon at AdventHealth.
And with NPH, this is not an easy task.
Diagnosing NPH is not necessarily all or nothing; there's no clear-cut path to a definitive diagnosis, says Dr. Behrmann. The goal of our screening and evaluation process is to make diagnosing NPH more quantifiable, and to identify the patients with NPH who would most likely benefit from treatment, which is the placement of a shunt.


Symptoms of NPH

There is a triad of symptoms that defines NPH: urinary incontinence, trouble walking, and memory problems, explains Dr. Behrmann.
Patients with NPH may have one or two of these symptoms, and because they are common symptoms that can come with simply growing older, they are often overlooked or treated for other conditions. But patients who have been diagnosed with NPH in its earliest stages before symptoms get worse respond better to treatment, which is why programs (like AdventHealth's) are so important.


Diagnosing NPH

Diagnosing NPH can be challenging, as no single test can diagnose it, notes Dr. Behrmann. However, the onset of one or more of the symptoms along with a magnetic resonance imaging (MRI) or computed tomography (CT) of the brain is a good place to start.
Often, these symptoms are identified by a primary care physician or neurologist, who then makes a referral to the NPH program at AdventHealth for further evaluation and testing. 


AdventHealth's NPH Program Evaluation

AdventHealth's program is specifically designed to evaluate and treat NPH. Taking a team approach, healthcare professionals from several areas of medicine, including geriatrics, nursing, physical therapy, neuropsychology, internal medicine, neuroradiology, and neurosurgery, work together with a specific testing protocol. This may involve a three-day admission to AdventHealth.


Initial Treatment of NPH

During this three-day admission, a small plastic catheter (an external lumbar drain) is placed in the back to allow the excess CSF from around the brain to drain at specific times.
Additionally, walking ability and memory function are assessed before any fluid is drained, and again after 48 hours of continuous drainage. Each patient is monitored closely by nursing staff who watch for any changes in symptoms.
Based on the patients level of improvement during testing, we can suggest a probability (from low to high) that the patient will respond positively to permanent shunt treatment, advises Dr. Behrmann.
Shunt placement is a surgical procedure that is performed by a neurosurgeon. It takes about one hour and does not have a long post-op recovery time, adds Dr. Behrmann.
The shunt is implanted under the skin to divert the excess fluid from around the brain to the abdominal cavity. This tube is regulated by a valve that opens and closes based on the amount of fluid in the brain at any given time, and thereby regulates the correct amount of CSF.
Patients are usually admitted to the hospital for the procedure and go home the next day.
Dr. Behrmann says, We find that many patients feel immediate relief of symptoms and continue to have positive results long-term. I enjoy seeing patients benefit from our program we can often offer help and hope.
For more information about AdventHealth's NPH program, contact the NPH care coordinator at Call407-303-3282 or visit the AdventHealth Neuroscience Institute.

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