Mickey Goldberg meg at lsr.nei.nih.gov
Tue Jan 3 12:31:43 EST 1995

jd.kronicz at pao.paonline.com wrote:
: I'm looking for information/advise on hydrocephalus.  My mother was 
: diagnosed with the condition about a week ago and the doctors seem to 
: think she should undergo surgery to relieve the resulting pressure.  She 
: was involved in a very nasty accident about three weeks ago and as a 
: result of the CT scans performed subsequently the condition was 
: identified.  She later had some MRI scans done which confirmed the 
: condition.  The doctors think that it is unlikely that the condition is 
: a result of the accident because, according to them, the condition 
: generally takes awhile to develope.  They want her to have an additional 
: test performed (cisterography) in order to verify that the condition is 
: due to a lack of reabsorption.  At that point I think they will 
: recommend that she should have a shunt surgically implanted. From what 
: I've read of the procedure it sounds somewhat dangerous and susceptable 
: to future complications.  I'm wondering specifically whether there are 
: other treatments available or on the horizon which would be less 
: invasive and whether this condition requires immediate treatment or 
: whether they might hold off to establish whether the hydrocephalus is 
: having a detrimental effect on her and also to see whether other 
: treatment options become available.  Any help would be greatly 
: appreciated.

Shunting is definitely the only treatment for so-called normal
pressure hydrocephalus.  The procedure should be done if and 
only if she is symptomatic from it:  the cardinal symptoms of the
disease are dementia, incontinence, and gait disturbance. Before the
accdident did you notice any change in her personality?

The cisternogram is one method of diagnosis.  A better one is
to do a full psychometric evaluation, then a provocative draining
lumbar punction, and repeat the psychometrics immediately after
the lumbar puncture.  If she is symptomatic from the hydrocephalus
she should improve her performance on the psychometrics.

M. E. Goldberg, M.D.
National Eye Institute

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