Fans of America’s favorite “Piano Man,” Billy Joel, were saddened to learn that his career has been put on hold since he developed normal pressure hydrocephalus – a condition most people have never heard of.
Exactly what is this condition with the lengthy name?
Dr. Oszkar Szentirmai, a neurologist at Cleveland Clinic in Tradition, explains that it’s commonly known as water on the brain. “The brain produces lots of fluid, and most of it is absorbed by the body. But in some people, the brain is not capable of moving the fluid,” he says.
“In normal pressure hydrocephalus (NPH), cerebrospinal fluid (CSF) builds up inside your skull and presses on the ventricles in your brain. Excess CSF can be diverted from the brain to another body cavity, most commonly the abdominal cavity, through a surgical shunt. This procedure helps to relieve the pressure on the brain caused by the buildup.
“Normal pressure hydrocephalus differs from high pressure hydrocephalus in that the latter involves a blockage in the CSF flow, leading to significantly elevated pressure within the skull that, if untreated, can kill you quickly.”
Dr. Szentirmai says that NPH is more prevalent in people 60 and older and presents a trio of symptoms: problems with balance, memory issues, and poor bladder control.
Yale Medicine concurs, stating it’s estimated that more than 700,000 people in the U.S. have NPH, although under 20 percent of them have been diagnosed with the condition. People with NPH often have an unsteady gait, cognitive impairment, and problems with bladder control. In the United States, NPH may cause up to 5 percent of dementia cases.
“There are many conditions that have these same symptoms,” says Dr. Szentirmai. “It’s not simple to diagnose because of this.”
Johns Hopkins Medicine explains that NPH risk factors include advanced age, a history of brain injuries, brain infections or brain surgery, and in some cases, brain tumors. Men and women are affected equally.
NYU Langone, a top-ranked academic medical center, explains some of the diagnostic tools used in evaluating potential patients.
Gait evaluation: A doctor asks you to take a few steps to determine if there is something unusual about the way you walk. The doctor may also videotape a person’s gait while he or she walks on a special computerized mat. This measures a person’s pattern of walking, called gait analysis.
Neurological evaluation: A doctor may perform a neurological evaluation to assess if there is any cognitive impairment. People who have normal pressure hydrocephalus sometimes develop mild dementia that may cause forgetfulness, short-term memory loss, and difficulty dealing with everyday tasks.
CT scan: X-rays and computer imaging create detailed pictures of the brain. The doctor may use this test to identify if the ventricles are enlarged, indicating cerebrospinal fluid buildup.
MRI scan: An MRI scan allows a better view of the brain, provides information about surrounding brain tissues, finds enlarged ventricles, and evaluates the flow of cerebrospinal fluid.
Lumbar puncture: Also known as a spinal tap, this determines how much pressure is caused by cerebrospinal fluid.
Lumbar drainage: A thin, flexible tube called a catheter is inserted into the lower back through a needle and left in place to drain cerebrospinal fluid into a bag. About one half of an ounce of fluid is drained every hour.
Dr. Szentirmai explains that NPH can be diagnosed at an early or late stage. “Once you have it, you have it, although treatment can be effective for many years for some people. Technology has greatly helped the effectiveness of treatment,” he says.
“NPH doesn’t kill you but it’s disabling. It makes independence difficult. And it’s more common than people think.
“Being informed is key to successful diagnosis and treatment.”
Dr. Oszkar Szentirmai practices at Cleveland Clinic’s HealthPark Two in Tradition. He got his medical education at Semmelweis University of Medicine in Budapest, Hungary; did a postdoctoral fellowship at Massachusetts General Hospital/Harvard Medical School in Boston; completed his residency at University of Colorado School of Medicine in Denver; and completed a fellowship in endoscopic skull base surgery at New York Presbyterian/Weill Cornell Medical Center. He is board certified in neurological surgery. Call 877-463-2010 for an appointment.
