Indiana Medical Malpractice lawyer discusses normal pressure hydrocephalus.
A few years ago I was involved in a medical malpractice case involving normal pressure hydrocephalus in a rural clinic. The problem in medicine is sometimes conditions that take a period of time to develop go unrecognized because healthcare providers start to take their patients for granted and do not give the same importance when symptoms increase or change. You know the saying – familiarity breeds contempt.
Symptoms of Normal Pressure Hydrocephalus (NPH)
Many textbook medical conditions have hallmark features – NPH is one of them and it is reported to have a clinical triad of symptoms. A triad is three conditions linked together. Reiter's syndrome is another medical condition with a triad of symptoms to include (conjunctivitis, urethritis and arthritis). NPH's classic triad is dementia, changes in gait, and urinary problems (incontinence).
Central Nervous System Anatomy
In order to understand the symptoms of NPH, it is important to get a brief understanding of the central nervous system (CNS). The CNS is a closed system made up of the brain and spinal cord. The brain and spinal cord are bathed in a fluid called cerebral spinal fluid (CSF). The CSF is made and travels through a number of cavities (holes) in the brain called ventricles. CSF has a number of biological functions including feeding the brain with nutrients and removing waste products. It also cushions and protects the brain.
What is Hydrocephalus?
Hydrocephalus is a medical condition that occurs when there is an increase in CSF in the ventricles. The movement of CSF is blocked or disrupted and because fluid builds up, pressure builds up and the ventricles can compress different parts of the brain.
This condition happens in older adults. NPH is different from other types of hydrocephalus (such as traumatic) because it takes a long time to develop. Because the onset of the condition is slow, the patient's onset of symptoms is often gradual. And as said above, the classic triad of urinary problems, dementia, and changes in gait (the ability to walk) are common with aging. If the healthcare provider doesn't consider NPH in her differential diagnosis the appropriate tests will not be performed, the condition will be missed and the patient will suffer serious brain damage.
NPH can be diagnosed with a spinal tap. If the CSF pressure measurement is increased, the working diagnosis should be NPH. Typically, patients will notice some of their symptoms improving after CSF is removed during the spinal tap. Diagnostic imaging studies such as CT and MRI can show changes in the ventricles and cisterns, which are causing pressure on other structures of the brain.
The goal of treatment is to decrease the amount of CSF so it doesn't put pressure on the brain. Most of the time a neurosurgeon puts a shunt in the brain to divert CSF from the brain to another part of the body. If the fluid is decreased, the pressure is decreased and the brain structures aren't damaged. If NPH is diagnosed quickly, patients' symptoms have a good chance the symptoms will go away.
Medical malpractice occurs when the healthcare provider fails to work the patient up for NPH and pushes the symptoms off to old age and diagnoses the patient with Alzheimer's, senile dementia, arthritis causing walking difficulty and chronic urinary problems.