Brain Drain: How To Treat Normal Pressure Hydrocephalus

The following is an excerpt from MdMD for Life 2011, available now.

Three years ago, James Cumberpatch noticed that he was having difficulty walking. “I’d come to a step and feel nervous about stepping up,” he recalls. Then he started to fall. He fell in the front yard and needed to crawl to the car to pull himself up. When he discovered he could no longer balance his checkbook, he knew something was wrong and went to his doctor.

“The doctor thought it might be Parkinson’s,” says Cumberpatch, 88. The doctor sent him to a specialist. “[The specialist] examined me and he said, ‘I don’t think you have Parkinson’s, I think you have hydrocephalus.’” And I said, “What the heck is that?”

Normal pressure hydrocephalus (NPH) is an abnormal increase of cerebrospinal fluid in the brain’s ventricles, which causes the ventricles to enlarge and put pressure on the brain. The symptoms of hydrocephalus include trouble walking, progressive cognitive impairment and loss of bladder control. The disease is common in people over age 65, but because its symptoms are similar to other illnesses common to that age group such as Parkinson’s and Alzheimer’s disease, it is often misdiagnosed.

Cumberpatch was fortunate that the specialist referred him to Michael A. Williams, M.D., medical director of the Sandra and Malcolm Berman Brain & Spine Institute of LifeBridge Health. Williams began his work with NPH more than two decades ago as a neurologic intensive care specialist treating patients who present with acute, life-threatening forms of the disorder. “I thought we should be able to apply some of the same approaches from the acute illness to patients with chronic forms of hydrocephalus,” he recalls. “Before I knew it, I was seeing more people with normal pressure hydrocephalus than anyone else around.”

The Adult Hydrocephalus Center, located at Sinai Hospital, one of only a few dedicated centers for NPH in the country, includes neurologists, neurosurgeons, neuropsychologists and a nurse practitioner. Although Williams considers himself a specialist in the field of NPH, because of the age of the patient population, he is something of a detective of neurologic disorders in the elderly, weeding out what is NPH and what is dementia, for example. “We work through a number of geriatric neurology Issues with our patients,” he explains. “I think of my job as sorting out not only the possibility of hydrocephalus, but the other possible causes of these symptoms.”

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-Christianna McCausland

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