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Suggest Treatment For Normal Pressure Hydrocephalus
Question: My husband has normal pressure hydrocephalus and has had a shunt since 2010. In the passed two years we started to get where he couldn't walk very far.This summer there were time he passed went to the ER and couldn't find a reason. XXXXXXX 19th he stood up and fell backwards again went to the Er couldn't find a reason. He is dizzy all the time and has no balance and has fallen twice. we have been to the neurosugeon and she has no answer
Brief Answer:
Orthostatic hypotension and parkinsonian syndrome must be excluded.
Detailed Answer:
I read your question carefully and I understand what you are going through.
If your husbands' symptoms are related only to normal pressure hydrocephalus then unfortunately the only proven treatment is the surgical one which he's had. It's effect is variable from one patient to the other even if the procedure has been correctly done, so it could be the case of symptom progression. As I said there are no really prognosis changing drugs for that eventuality.
On the other hand before leaving it at that there are some other potential causes to be exluded as having one condition doesn't render him immune to others.
I assume he must have had some routine blood tests, vitamin b12 and thyroid function tests.
If those come back normal a cardiac evaluation and an ultrasound of neck vessels supplying the brain is recommended as well.
Two main possibilities causing balance issues at his age to be considered are orthostatic hypotension and Parkinson disease.
The first is evaluated by comparing blood pressure values between supine and standing. An excessive drop might mean orthostatic hypotension. If in doubt 24h blood pressure monitoring is useful.
Parkinson's is evaluated mainly by physical exam. However it's manifestations can overlap with those from HPN so often a levodopa treatment test is performed (levodopa is the mainstay of Parkinson treatment) to differentiate hudging from the response
I remain at your disposal for further questions.
Orthostatic hypotension and parkinsonian syndrome must be excluded.
Detailed Answer:
I read your question carefully and I understand what you are going through.
If your husbands' symptoms are related only to normal pressure hydrocephalus then unfortunately the only proven treatment is the surgical one which he's had. It's effect is variable from one patient to the other even if the procedure has been correctly done, so it could be the case of symptom progression. As I said there are no really prognosis changing drugs for that eventuality.
On the other hand before leaving it at that there are some other potential causes to be exluded as having one condition doesn't render him immune to others.
I assume he must have had some routine blood tests, vitamin b12 and thyroid function tests.
If those come back normal a cardiac evaluation and an ultrasound of neck vessels supplying the brain is recommended as well.
Two main possibilities causing balance issues at his age to be considered are orthostatic hypotension and Parkinson disease.
The first is evaluated by comparing blood pressure values between supine and standing. An excessive drop might mean orthostatic hypotension. If in doubt 24h blood pressure monitoring is useful.
Parkinson's is evaluated mainly by physical exam. However it's manifestations can overlap with those from HPN so often a levodopa treatment test is performed (levodopa is the mainstay of Parkinson treatment) to differentiate hudging from the response
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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