Wacky Wobbly and Wet

Normal pressure hydrocephalus (NPH) is a chronic type of communicating hydrocephalus whereby the increase in intracranial pressure (ICP) due to accumulation of cerebrospinal fluid (CSF) becomes stable and that the formation of CSF equilibrates with absorption. It produces various symptoms that range from dementia (wacky), ataxia (wobbly) and urinary incontinence (wet).

The ICP gradually falls but still maintains a slightly elevated level and the CSF pressure reaches a high normal level of 150 to 200 mmH2O. Measurements of CSF, therefore, are not usually elevated. Because of this equilibration, patients do not exhibit the classic signs of increased intracranial pressure such as headache, nausea, vomiting, or altered consciousness. (Though some studies have shown pressure elevations to occur only intermittently). However, patients do exhibit the classic triad of gait difficulties, urinary incontinence, and mental decline. It is often misdiagnosed as Parkinson’s disease, Alzheimer’s disease, and senility due to its chronic nature and its presenting symptoms¬† It is known that NPH is primarily due to inability of the CSF to be absorbed by the arachnoid villi. It may occur secondary to post-traumatic meningeal hemorrhage.

Treatment: Shunts (which are kinda expensive) to drain the excess CSF and may alleviate some of the symptoms.

For more information: Normal pressure hydrocephalus – Wikipedia, the free encyclopedia


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