Hydrodephalue, a rare but often correctable form of dementia
DEAR DR. DONOHUE: My mother is 86. Up until eight months ago, she was very active and very social. She still drove a car. Since then, she has suffered a big decline. Her memory is bad, and she can’t seem to focus on anything. She gives you a blank stare. Her doctor referred her to a neurologist, who came up with the possible diagnosis of normal pressure hydrocephalus. She’s scheduled for more tests, and the doctor mentioned surgery. Is an 86-year-old up to brain surgery? What is this? — J.A.
ANSWER: Hydrocephalus is water on the brain, something most often associated with infants who have a blockage of cerebrospinal fluid. Cerebrospinal fluid circulates through hollows in the brain called ventricles and flows over the brain and spinal cord. It nourishes brain cells and cushions the brain.
Adults with normal pressure hydrocephalus, NPH, have too much fluid in their brain ventricles. The fluid expands the ventricles and compresses brain cells.
A triad of symptoms and signs results and constitutes NPH. One sign is a walking disturbance. Affected people look like their feet are glued to the ground when they take a step. They have trouble lifting each foot off the ground. When they turn, they do so with a series of small, shuffling steps. The second sign is loss of bladder control — urinary incontinence. And the third NPH sign is dementia, a deterioration of mental function. Memory loss is one aspect. The inability to concentrate on a task or instructions is another NPH dementia sign.
Not all NPH patients have all three signs.
An MRI brain scan shows the dilated brain ventricles. Other tests add validity to the diagnosis. Some doctors remove spinal fluid through a lumbar puncture in the back. Drainage of fluid can improve symptoms, but it doesn’t always do so.
Your mother, at 86, is up to surgery for NPH. The surgery consists of inserting a thin, plastic tube into the brain ventricles to drain off the fluid to other body sites. That often restores brain function.
I have to caution you not to get your hopes up too high. NPH is a rare disorder. However, in some patients, treatment can be most rewarding.
DEAR DR. DONOHUE: Can a 17-year-old have a stroke or heart attack? My son is overweight and has high blood pressure and high cholesterol. He tends to think that his age is on his side and he is not really at risk for either. What do you think? — D.D.
ANSWER: It’s possible for a 17-year-old to have a stroke or a heart attack, but either would be a most rare occurrence, even in someone who is overweight and has high blood pressure and high cholesterol.
Age is on his side — temporarily.
The ravages of obesity, high blood pressure and high cholesterol are effecting changes in his body, particularly his arteries, that will shorten his life and eventually lead to either a stroke or diabetes. He has to start working on these problems right now if he doesn’t want to have an obituary written about him at an age when he should still be an active person.
DEAR DR. DONOHUE: Every year I come down with tonsillitis. Every few months, I have to go on antibiotics for it. My doctor wants me to have my tonsils removed. I thought that tonsil removal was a thing of the past and that it never was done for someone my age — 34. What are your recommendations? — P.C.
ANSWER: At one time, tonsillectomy was a common childhood operation. Those were the days before antibiotics. Adults can come down with tonsillitis. They do so less frequently than children because adult tonsils have shriveled.
If a person has seven bouts of tonsillitis in one year, five episodes in two consecutive years or three attacks in three consecutive years, doctors often recommend tonsil removal.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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