Sunday, April 22, 2012

Normal Pressure Hydrocephaly(us)

Before my wife and I moved to our little southern town of Arab, Alabama, I had been experiencing some steadily worsening symptoms in my walking.  More and more frequently, I would trip, having caught my right foot on anything from a crack in the sidewalk to a step in an auditorium.


(At the risk of giving away the punch line here, there were other symptoms.  I had developed a problem of urinary incontinence, not frequent, but still bothersome, to say the least.  In addition, going as far back as three or four years, prior to my retirement, I was having difficulty at work in what would normally have been straightforward problem solving.)


Back to the issue at hand, I went out one day for a walk through the golf course that lies behind the condo we rent.  It was early June and already getting warm.  I walked through most of the back nine holes and arrived at the club house.  I felt I needed some hydration and, as it turns out, the club house is near the local Wal-Mart.  I stopped in the store to get some water and headed out down the four lane divided highway that would take me back to my street.
After about a quarter mile going down the breakdown lane, I started having trouble walking.  It was not so much the gait problem to which I was accustomed, but a sense that my upper body was moving ahead of my legs.  


Suddenly, I was lying on the ground surrounded by three Good Samaritans who had stopped when they saw me on the ground.  They called for an ambulance which took me to the nearest emergency room at Marshall County Medical Center in Guntersville, Alabama.
Once the doctor discovered that I had been having this gait problem, he asked two other key questions that no other physician had asked:

  1. Have you had any incontinence problems?
  2. Have you had any indication of early dementia?

In addition to being floored at the relevance (to us) of the questions, we learned that I might have a condition called Normal Pressure Hydrocephaly.  It results when the brain fails to drain cerebral spinal fluid from cavities called ventricles.


The doctor ordered a CAT scan of my brain and suggested I see a neurologist.


To make a long story short, I was positively diagnosed with the condition and referred to a neurosurgeon who recommended that I have a kind of surgery called a shunt placement.  The shunt drains the spinal fluid into you abdominal cavity where it is absorbed by other organs.  When I resisted a quick decision, he simply asked if I want to pee on myself for the rest of my life.  Decision made.


Post surgery, relief of all symptoms was practically immediate.


Why do I bother the internet with these experiences?  This condition is not diagnosed as frequently as it occurs.  Sometimes it is diagnosed as early onset dementia or Alzheimer's Disease.  Sometimes (as in my case) the suggestions were that I pay more attention to my walking and my cognitive tasks.


Because of this triad of symptoms, it is frequently misdiagnosed as other conditions.  So I write this as a kind of public service announcement regarding a condition that may affect many individuals and for which there is a relatively painless remedy.


Sometimes physicians diagnose what they are accustomed to treating.  I had four physicians (internist, orthopedic surgeon, psychiatrist, urologist) to whom I had described what I thought was the relevant symptom.  They diagnosed based on the one symptom and passed it off as something else entirely.


So, be attentive to your body as you age.  And if you see a physician, make sure you describe all symptoms whether or not you think they are relevant.  If you are worried about one or more in particular (both my wife and I worried about dementia but neither articulated the extent of our worry), your solution may exist and may dispel your fears.

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