Normal Pressure Hydrocephalus Swells the Brain From The Inside

Ventricles Look Like Lake Michigan

SPECT Helps For NPH Evaluation

Single Photon Emission Computed Tomography putting the T [Tomography – brain slice] in SPECT Brain Imaging.

The Tomographic View: The operational word for this post is Tomography.  Tomography slices provide an accurate, measurable difference for NPH: Normal Pressure Hydrocephalus – see the Video  [showing the typical gait] at the bottom of this page for more information about how this exceedingly treatable condition is so frequently overlooked.

These brain slices reveal what I saw on [many] tomographic views/slices provided by the patient for a second opinion on brain deterioration. The surface 3-D renderings, looked actually quite good – but looking at the slices, the inside of the brain, there was another story. Take a quick look at this brain sliced tomographically with SPECT imaging, and see if you see what immediately came to my attention: Those blue areas in the center simply shouldn't look like this: these pictures are the blue holes of swollen ventricles, on multiple levels, multiple slices. across the brain.

NPH – Normal Pressure Hydrocephalus Clinical Findings

The Clinical Triad: 1. Gait Disturbance [Ataxia] with falling, 2. Dementia, 3. Urinary Incontinence. But let's start at the beginning: Chief Complaint in this 65 yo male: memory deterioration, long-standing ADHD symptoms recently worse, no head injury, and, yes, some clear metabolic problems… – but the big finding in the tomographic slices – big holes in the center of the brain, where the ventricles have swollen and ballooned out. Those blue areas are the ventricles, filled with cerebral spinal fluid, pushing the brain out against the skull. And for the neurologists out there, this patient demonstrated no fixed gait, no incontinence – in fact he is “compulsive” about working out.

The 3-D surface SPECT images

SPECT showed some other typical findings: prefrontal cooling [inadequate blood perfusion] with a history of ADHD, temporal lobe cooling with not understanding communications well, and anger “out-of-the-blue.” His previous SPECT report pronounced him free of Alzheimer's and no frontal-temporal dementia, but this is the beginning of the rest of the story. The tomographic slices told a different story for this atypical “healthy guy,” with memory problems and a history of ADHD. First this commentary from the Neurology Channel, then see the video below to clarify NPH diagnostic details.

Overview on NPH

The Neurology Channel gives this additional overview:

“Normal pressure hydrocephalus (NPH) is a condition that involves the build-up of fluid in the brain. Normally, a fluid called cerebrospinal fluid (CSF) circulates around the brain and spinal cord. This fluid cushions, cleanses, and brings nutrients to the cells in the brain and spine. CSF is produced in small, hollow spaces within the brain called ventricles. For people in good health, excess CSF normally drains away into the bloodstream as fresh CSF is produced.

When cerebrospinal fluid does not drain properly, the cerebrospinal fluid builds up in the ventricles and NPH can occur. This build up puts pressure on the brain, interfering with healthy brain function. NPH most commonly affects the areas of the brain that control leg movement, bladder function, and cognitive abilities such as problem solving, speaking, and remembering.

‘Hydrocephalus‘ was once called ‘water on the brain,' but we now know that the water is CSF. The term ‘normal pressure' refers to the fact that this type of hydrocephalus, which generally develops slowly, has a lower CSF-pressure than other types of hydrocephalus. Normal pressure hydrocephalus occurs mainly in people over the age of 60 and symptoms may be mistaken for other disorders, such as Parkinson's disease, Alzheimer's disease, dementia, or Creutzfeldt-Jakob disease. However, with proper diagnosis and treatment many of the symptoms of NPH can be controlled or greatly reduced. In some cases, a nearly complete recovery is possible.”

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Excellent NPH Video Report – 9:25 min

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Treatment With A Shunt

Shunt technology, to run the CSF back into the blood stream, has improved and this condition can likely be significantly corrected. This SPECT case proved the truth of the axiom: we do need to look at the brain to see what's going on, and in this case, inside the brain.

Shunt Information Video – 8:36 min

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Tomographic Views with SPECT brain imaging provide considerable diagnostic assistance for NPH diagnosis.

cp
Dr Charles Parker
Author: New ADHD Medication Rules – Brain Science & Common Sense

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