Talk:Normal pressure hydrocephalus

In the sentence "However, in NPH there may be an obvious discrepancy between (often severely) impaired recall and intact or much less impaired recognition," shouldn't the last word be "cognition"? Burntsidefinn (talk)

How

How long does this take to develop? What type of onset? A few days, or a few decades? I think the article should address this.

__________

My mother has NPH, she started to develop the symptoms over 10 years ago, when she started falling over and was unable to walk properly. Her mental state has deteriorated steadily and has now progressed to the dementia stage. She has just been given medication for it.

It's probably different for every patient -- "Did I not just use the word 'puzzling'?" 18:13, 28 July 2011 (UTC) --

The opening to this article is: "Normal pressure hydrocephalus (NPH), also termed symptomatic hydrocephalus, occurs when there is an increase in intracranial pressure (ICP)..." This doesn't sound right - shouldn't the ICP be normal in NPH? — Preceding unsigned comment added by 94.172.108.59 (talk) 21:42, 28 July 2011 (UTC)

Harold Conn

Harold O Conn, retired physician, has taken it upon himself to inform the profession of his illness (NPH). See Clin Med 2007;7:296–9 (not yet indexed) for his account. JFW | T@lk 11:58, 24 June 2007 (UTC)

Unclear

This sentence: "Most patients who have continued success with such shunts usually only have two of the three triads (excluding incontinence)." is entirely inscrutable. Does this mean that people who get the shunts, and have their ventricles return to normal size only see a benefit in urinary urgency? Or does this mean that some Asian gang members (Triads?) are somehow involved? Or does this mean that people who only had two of the three main symptoms (Wacky and wobbly) show any improvement from shunting? I'm going to give it a go at re-writing this, under the assumption that it should be about treatment outcome. --MTHarden (talk) 04:08, 7 March 2008 (UTC)

Lumbar infusion test

NICE has been looking into the evidence: http://www.nice.org.uk/guidance/index.jsp?action=byId&o=11908 JFW | T@lk 07:44, 25 June 2008 (UTC)

Research on shunt efficacy

A recent study on shunt efficacy has been completed and published: Journal of Neuroscience: http://thejns.org/doi/abs/10.3171/2010.11.JNS10967?prevSearch=allfield%253A%2528hydrocephalus%2529&searchHistoryKey= —Preceding unsigned comment added by 122.99.89.14 (talk) 05:15, 10 February 2011 (UTC)

Often mistaken for dementia

The article says the condition is often mistaken for Alzheimer's disease. Is it not also commonly mistaken for other forms of dementia? I am no expert on this condition, so would not like to edit the article, but heard on "Inside Health" on BBC Radio 4 today (Wednesday March 3 2021) that the condition is often mistaken for dementia. Since there are forms of dementia other than Alzheimer's disease, the article could discuss whether the condition is sometimes mistaken for other forms of dementia, such as vascular dementia or dementia with Lewy bodies. Rollo August (talk) 16:58, 3 March 2021 (UTC)

@Rollo August: Hi. Just my two cents ... One must keep in mind that dementia (a.k.a. senility) is a blanket/"generic" term for neurocognitive deterioration that may be caused by any of a number of various brain pathologies at any age. The most common cause of dementia overall is Alzheimer's disease, which also presents without additional distinguishing symptoms (as is the case with e.g. Lewy body dementia, or frontotemporal dementia), and does not have a known cause (as is the case with e.g. dementia resulting from syphilis, alcohol use, or HIV/AIDS).

Dementia is one of the primary symptoms of NPH. Of course, dementia in a patient may also be caused by any of a number of possible causes which need to be excluded to establish a diagnosis of either AD or NPH (which I think is implicit in the article already). I guess other causes of dementia could theoretically be listed as differential diagnoses here, however, if dementia is the only presenting symptom (or it is the only noted symptom), one could just syllogistically look for differential diagnoses in the dementia article.

Kind regards, -J Jay Hodec (talk) 19:25, 9 March 2021 (UTC)

Wiki Education assignment: WikiProject Medicine Winter 2024 UCF COM

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 January 2024 and 2 February 2024. Further details are available on the course page. Student editor(s): Jsilliman (article contribs).

— Assignment last updated by Jsilliman (talk) 21:37, 10 January 2024 (UTC)

Workplan

Introduction

• Expand on risk factors associated with development of NPH

• Clean up grammar

Signs and symptoms

• Expand on classification/definition of “mild” gait deviation

• Expand on what the “newer guidelines” are for NPH classification as Adams triad is considered “obsolete”

• Minor grammatical changes

• Discuss how long it takes for the dementia-associated signs/symptoms to occur and how they progress

Pathogenesis

• Expand on why trauma, injury, hemorrhage, surgery can all be causes of secondary NPH

• Discuss neuroanatomy in relation to NPH and how impairment of these anatomical structures leads to the corresponding signs and symptoms

• Add citation for explanation of why individuals with NPH do not have the typical signs/symptoms of that accompany increased ICP

Diagnosis

• May be useful to add image here demonstrating Miller-Fisher test

• Expand on definition of CSF infusion test and lumbar test

• Add citation for evidence-based diagnostic criteria for primary NPH Treatment

• Discuss what is considered early and late disease course for NPH and guidelines for VP shunt placement based on the duration of signs/symptoms

• Add citation for acetazolamide/diuretics not being recommended as medication in NPH patients

• Research and expand on other management options aside from VP shunt and medications

Epidemiology

• Add percentage of cases that are primary NPH vs secondary NPH

• Discuss if differences exist in prevalence and incidence of NPH among different ethnicities

Add prognosis section.

— Preceding unsigned comment added by Jsilliman (talk • contribs) 22:53, 10 January 2024 (UTC)

Hi Julia,

These are high quality edits and additions to an important article. This is a topic I struggle with, and it was a pleasure learning more about it and seeing your contributions.

1.      Nice additions to introduction section. The lines on primary vs. secondary NPH was necessary and liked your inclusion of comorbidities/causes.

2.    The addition of the insidious nature of NPH in signs and symptoms is appropriate.

3.    You did a great job providing a concise and informative pathophysiology behind the “wet, wacky, and wobbly” signs of NPH. I liked the inclusion of how these conditions lead to secondary NPH. It may be helpful for readers to include an image of either the brainstem, corticospinal tract, or diagram of what ventricle expansion looks like. Additionally, for the dementia section, it is not clear which nerves’ “axonal fibers” are affected. If this is still ongoing research it may be useful to say “Dementia in NPH is most likely caused by ventricular enlargement compressing the calvarium, which leads to shearing of currently unidentified nerve fibers.”

4.    For the diagnosis section, it was a great inclusion of ruling out known causes before declaring Idiopathic NPH. I agree with including what the CSF infusion test is. I would have added an image of a lumbar puncture as stated in your workplan but I agree that it is not necessary since readers can just click on the hyperlink.

5.    The medications section is a really great addition. I know that some of our outdated textbooks still talk about acetazolamide. Are there any experimental medications in the works right now?

6.    The outcomes and prognosis section was also a very necessary addition to the article. What are some of the poor prognostic factors (i.e. early dementia?, rapid gait changes?, comorbid alcoholism? Etc.)

7.    Excellent history section. It is concise and very interesting to learn about origins of diagnoses and procedures.

Overall, great job with your edits and additions. I didn’t notice any grammar or punctuation errors. The edits are all concise and add high quality information. There were a few things from your workplan not included but I agree that their inclusion/exclusion doesn’t change overall understanding of the article. Good job. Sean Yumul (talk) 16:30, 30 January 2024 (UTC)