How to treat normal pressure hydrocephalus in the elderly?

Question

Hello doctor,

My grandfather is 85 years old and has an NPH problem, and we do not know how to solve the problem. Is it safe for him to do that at his age? I got a CT and an MRI scan for any future help.

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your concern, and I have seen the imaging studies (attachment removed to protect patient identity). If, before the problem, your father is 85 years old, active, can walk, can change clothes by himself, and can eat by himself, then a VP (ventriculoperitoneal) shunt insertion would help.

The imaging shows hydrocephalus, and some of the symptoms of NPH (Normal Pressure Hydrocephalus) may come from this. However, there is an obstructing tumor in the posterior fossa. As I see, this may be a metastasis of an epidermoid tumor. I would suggest further investigation with your neurosurgeon on this matter.

For the question of a VP shunt (ventriculoperitoneal shunt), the answer is yes, and this could help your father even if he is 85 years old. You need to have medical clearance from your cardiologist and pulmonologist to undergo the operation.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

A lumbar puncture would also help to rule out NPH (normal pressure hydrocephalus) at this point, and you would have to take into consideration, first, the obstructing tumor that blocks the fluid circulation in your father's brain. As I see, your father does not have an NPH, but obstructive hydrocephalus, proceeding with a shunt rather than a lumbar puncture is warranted.

I hope this helps.

Thank you.