Inova’s Normal Pressure Hydrocephalus Program: Providing Hope and a Novel Multidisciplinary Approach to Care

At Inova, our team is committed to providing the highest level of care to the “greatest generation.” Normal pressure hydrocephalus (NPH) is an often misunderstood and misdiagnosed condition affecting the older population. With expert diagnosis and proper treatment, however, we can help patients with NPH live full, productive and independent lives.

What is Normal Pressure Hydrocephalus?

Normal pressure hydrocephalus occurs when cerebrospinal fluid (CSF) builds up in the brain’s ventricles, the cavities within the brain. NPH usually affects people 60 years of age and older.

The body continues to produce spinal fluid in the brain at the regular rate; however, with aging, this fluid does not get reabsorbed at the same level. Over time, the spinal fluid buildup presses against the ventricles and causes pressure. The ventricles then push out against the brain. Symptoms usually include cognitive problems, urinary incontinence and walking difficulties.

NPH: Not Just “Normal Aging”

NPH is frequently underdiagnosed. This is because:

• The population it affects often attributes these symptoms to normal aging. Many times, patients and their families do not even realize that a visit to a specialist could lead to proper diagnosis and treatment.
• Some symptoms are similar to those of dementia, so patients may be misdiagnosed and left untreated or improperly treated.

In fact, unlike dementia, NPH is treatable with surgery. With the proper diagnosis and treatment, we can stop and even reverse the symptoms. Many patients may even return to independent living and enjoyment of their daily activities.

A Multidisciplinary Approach to a Complex Condition

At Inova, our multidisciplinary team is dedicated to the expert diagnosis and treatment of NPH. We are one of just a few centers that uses a collaborative approach to diagnosing NPH. By drawing on the expertise of a number of different specialists, we can guide our patients to the right diagnosis and effective treatment.

Our multidisciplinary team includes experts in:

• Neurosurgery
• Neurology
• Therapy
• Physical therapy
• Occupational therapy
• Speech therapy
• Radiology
• Nursing

Diagnosing Normal Pressure Hydrocephalus

The accurate diagnosis of NPH requires a multidisciplinary team. It’s a far cry from a simple scan or blood test. The most accurate means of diagnosing this condition requires a three-day hospital stay, during which we perform a lumbar drainage. Our expert nurses drain fluid from the lower back. This process is key because it simulates the effects of the surgical treatment for NPH.

During these three days, the team analyzes the results of the lumbar drainage:

• If the symptoms improve after the three-day drainage, we can predict the surgery will be beneficial. We then place a shunt (tubing) in the patient to provide continual drainage.
• If the symptoms do not improve after the drainage, this, too, gives us valuable information. It means we can rule out NPH as the cause of the symptoms. We can now refer those patients to more specialized testing to identify their condition and develop a treatment plan.

Advanced Technology in the Treatment of Normal Pressure Hydrocephalus

For patients who will benefit from treatment, we perform a surgical procedure to insert the shunt using small incisions on the scalp and abdomen. The shunt drains the fluid, preventing its buildup and the subsequent brain pressure.

In the past, if we needed to adjust the shunt, it required a separate procedure. Now, thanks to advances in shunt technology, we can offer our patients a programmable shunt. It enables us to make needed adjustments using external magnets without the need for a separate surgery.

NPH Program at Inova

We will continue to strengthen and develop our NPH program through our Movement Disorders and Memory programs, which will be one of the few dedicated programs of its kind in the region. We look forward to delivering the exceptional care and services that our patients and their families both need and deserve.