The symptoms of adult hydrocephalus develop slowly, usually in older adults. Unfortunately, all three symptoms (poor balance, urinary frequency, and cognitive difficulty) can be mistaken for normal signs of aging.
Even doctors aren’t always aware of the condition. It is rare, so most doctors don’t see it often. There is no single test that can diagnose it. And since all three of the symptoms could be explained by the aging process, doctors could easily miss the diagnosis without ever realizing it.
But Dr. Guy McKhann evaluates and treats hundreds of cases of adult hydrocephalus each year, sometimes with dramatic results. He believes it is crucial to educate patients and doctors about this treatable condition.
So what is hydrocephalus?
Hydrocephalus is a build-up of cerebrospinal fluid in the brain. Cerebrospinal fluid bathes and cushions the brain and spine. It delivers nutrients, removes waste products, and supports and protects these delicate structures.
The brain constantly produces new cerebrospinal fluid, while the bloodstream constantly reabsorbs existing fluid. Usually, this keeps that balance of fluid just right.
But sometimes there can be an imbalance between fluid production and absorption, and too much fluid can be present. The result is adult hydrocephalus. Its cause is unknown, but treating the imbalance can be life-changing.
Diagnosis is a multi-step process. Having just one symptom (like dementia) does not mean a patient is likely to have adult hydrocephalus. But having two or all three can be reason to test further. Usually problems with balance begin before cognitive difficulties and are more prominent
If a patient’s clinical history, examination, and brain imagery indicate that adult hydrocephalus is likely, Dr. McKhann performs a test removal of some cerebrospinal fluid. Patients who benefit from this removal are more likely to be helped by surgery.
There are two different surgeries that can correct the fluid imbalance. In one, Dr. McKhann implants a shunt, or thin tube, inside the body. The shunt drains the cerebrospinal fluid from the brain into an area where it can be absorbed more easily, like the abdomen. Dr. McKhann uses programmable shunts that allow him to fine-tune the balance of fluid production and drainage.
The other procedure is called an Endoscopic Third Ventriculostomy. “Endoscopic” means that the surgeon uses a tiny camera and micro-instruments. In this procedure, Dr. McKhann makes a small hole in one of the chambers in the brain where cerebrospinal fluid is produced. The fluid can drain through this hole.
Dr. McKhann has great technical expertise with both types of surgery, and also has the experience and understanding to determine which surgery to use for which patient. Recently, he shared his expertise and understanding of adult hydrocephalus with other neurosurgeons. He led a seminar on the condition at the 2015 meeting of the American Association of Neurological Surgeons. Attendees learned the anatomy of the disease, the intricacies of patient evaluation, and the relative merits of the two types of surgery.
Familiarizing other neurosurgeons with adult hydrocephalus is important to Dr. McKhann. The more physicians who have a good understanding of the disease, the more patients will be correctly diagnosed and treated.
Photo credit: “Hope for Balance” (c) [Bob ~ Barely Time 4 Flickr] / Flickr
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