Another Thing To Think About

Yesterday I blogged about falls. In that blog I mentioned a little known condition of the elderly, normal pressure hydrocephalus. I thought I’d follow-up on that today.


Normal pressure hydrocephalus is a neurological condition that affects the brain. Hydrocephalus means water on the brain. It would be more accurate to say water in the brain. In this case, too much water – the water being cerebrospinal fluid.


Cerebrospinal fluid (CSF) is a straw colored fluid that surrounds the brain and spinal cord. It is filtered from blood that circulates through very small blood vessels within four spaces in the brain. The spaces are called ventricles. The CSF flows from the ventricles into the subarachnoid space which surrounds the spinal cord and the brain. It is eventually re-absorbed. This process is the CSF circulation.


Hydrocephalus occurs when the normal flow of the CSF is blocked so that there is a back up of CSF in the ventricles. This causes the ventricles to enlarge and exert pressure on the brain from the inside. Hydrocephalus can occur from an obstruction to the circulation of CSF, from overproduction of CSF or from poor re-absorption of CSF. Sometimes the cause of normal pressure hydrocephalus is unknown.


Abnormal pressure on the brain results in symptoms that can vary greatly. Some of these symptoms may be related to changes in walking: weakness in the legs, sudden unexplained falls or unsteadiness when walking. As the pressure on the brain continues the symptoms become more severe and may include: memory loss, difficulty with speech, lack of interest in surroundings and episodes of urine or bowel incontinence. Normal pressure hydrocephalus may accounts for 5% of all dementias.


The treatment for hydrocephalus is surgery to shunt the excess CSF from the ventricles to another part of the body where it can be re-absorbed. The extent of recovery depends on the cause of the hydrocephalus and how much damage it has done to the brain.


Normal pressure hydrocephalus is another thing to think about when someone, especially someone over 65, has unexplained falls or changes in behavior.




Mary Lou Bernardo, PhD, MSN


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