NPH: Reversing Brain Disorder?


ORLANDO, Fla. (Ivanhoe Newswire) — Imagine you or a loved one are walking normally, then slowly you start to shuffle.  You lose bladder control, and possibly most frightening, your memory starts to fade. These are all symptoms that point toward Parkinson’s or Alzheimer’s. There is one little known condition that mimics these diseases, but NPH patients can get better.

Seventy-year old Betty Smith has plenty of energy to keep up with her rescue dogs Holly and Oliver. A little more than two years ago her family noticed she was having trouble walking.

Betty’s sister-in-law, Sandi Smith said, “We called it a waddle to begin with. She just seemed to kind of waddle.”

Then Betty began to fall whenever she changed directions. A neighbor had been diagnosed with Parkinson’s, one of Betty’s worst fears.

“She had a very bright mind trapped in a body that couldn’t function,” Betty shared with Ivanhoe.

Manoucher Manoucheri, MD, Internal Medicine, is director of the NPH Program at Florida Hospital.

“It is critical to diagnose NPH early; it is the only reversible condition you can actually help the patient with,” Dr. Manoucheri said. (Read Full Interview)

Normal pressure hydrocephalus is a buildup of cerebral spinal fluid in the brain’s cavities. One of the obvious symptoms is a shuffling gait, much like this patient, posted on social media.  Surgeons implant a shunt to slowly drain excess fluid from the brain.

“It is basically a tube placed in the ventricle and subcutaneously goes into peritoneal cavity,” Dr. Manoucheri explained.

For some patients, like Betty, when the pressure is gone they begin to recover.  A few months after surgery, Betty was traveling with a friend to Budapest and her sister-in-law to Alaska. Betty says she’s better than normal.

Betty shared, “It’s this big smile on my face. I’ve had my own personal miracle. I’m very, very blessed.”

Dr. Manoucheri says with early diagnosis, many patients have their symptoms reversed. If the condition is not treated, it can worsen, and may cause death. In about half of the cases, a brain injury, caused by infection or trauma, causes the fluid buildup.

Contributors to this news report include: Cyndy McGrath, Field and Supervising Producer; Hayley Hudson, Assistant Producer; Roque Correa, Videographer; Roque Correa, Editor.

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BACKGROUND: Dr. Manoucher Manoucheri, MD, Internist and Faculty Member at Florida Hospital Internal Medicine Residency and Associate Program Director in charge of the NPH Program at Florida Hospital explains that NPH stands for normal pressure hydrocephalus. This is increased cerebrospinal fluid accumulation in the brain. Cerebrospinal fluid or CSF is a clear colorless fluid that bathes the brain and spinal cord. Cerebrospinal fluid is produced in one part of the brain and then circulates around the brain and is reabsorbed. If the patient is unable to reabsorb the fluid appropriately then the fluid accumulates and causes the enlargement of the ventricle, hence the terminology normal pressure hydrocephalus.

(Source: Manoucher Manoucheri, MD)


SIGNS: Dr. Manoucheri explained that normal pressure hydrocephalus could gradually develop over a period of time. One of the most prominent features of normal pressure hydrocephalus is gait abnormality. Elderly patients find themselves with poor balance and a shuffling gate. It is often misdiagnosed as Parkinson’s disease because cognitive decline could also develop. Some patients also have urinary incontinence that could be confused with overactive bladder. The dementia symptoms of NPH can be similar to those of Alzheimer’s disease. The walking problems are similar to those of Parkinson’s disease. Experts say that many cases of NPH are misdiagnosed as one of these diseases. The good news is that, unlike Alzheimer’s and Parkinson’s, NPH can be reversed in many people with appropriate treatment. But first it must be correctly diagnosed.

(Source: Manoucher Manoucheri, MD &


TREATMENT: Dr. Manoucheri said that they diagnose normal pressure hydrocephalus based on clinical presentation and imaging. Imaging modalities that are used for normal pressure hydrocephalus either include an MRI or a CAT scan of the brain. On these images, doctors see  characteristic changes. After diagnosis, patients enter the program and get complete neuropsychiatric evaluation before the lumbar drain placement. Patients also get a physical therapy assessment including walk tests and gate assessment, and the lumbar drain is placed; doctors remove fluid periodically for 48 hours. On day three doctors do an assessment again with a neuro psych evaluation and physical therapy and then determine if there is sufficient improvement in any of those parameters. Patients usually show improvement within a week.

(Source: Manoucher Manoucheri, MD)



Karina Saad, PR


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Doctor Q and A

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