Article

As society ages, memory decline and brain degeneration have become hot topics. There are many causes of brain degeneration, with common ones including Alzheimer's disease and vascular dementia. However, there are currently few treatment options for neurodegenerative diseases.

Although the causes of brain degeneration are diverse, one specific condition known as normal pressure hydrocephalus presents with a classic triad of symptoms: memory loss, gait instability, and urinary incontinence. This condition has the potential for significant improvement through treatment.

The phrase "water on the brain" is a metaphor used to describe issues with intelligence, suggesting that having too much fluid in the brain is abnormal. Under normal circumstances, cerebrospinal fluid surrounds the brain and nerves, protecting them from injury while removing metabolic waste. Cerebrospinal fluid is produced in the brain's ventricles and flows to the surface of the brain, where it is absorbed by veins. When various diseases occur within the skull, cerebrospinal fluid may not drain properly, leading to pressure on nervous tissue, increased intracranial pressure, and damage to the nervous system, affecting functions such as memory and movement.

Normal pressure hydrocephalus is most common in individuals over 60 years old. Patients typically exhibit symptoms such as memory decline, slowed thinking and movement, and difficulties with speaking and writing. They often experience gait issues, such as difficulty starting to walk, a feeling of feet being stuck to the ground, unsteady walking, and shuffling steps. In later stages, urinary incontinence may occur. These early symptoms can resemble those of other conditions, making them easy to overlook, which can lead to delays in seeking medical attention and missing opportunities for treatment.

Based on clinical presentations, doctors will arrange imaging tests for patients suspected of having cognitive decline. These tests may include CT scans and MRIs to identify any structural abnormalities, brain atrophy, or hydrocephalus. When brain neurons degenerate, brain atrophy occurs alongside an increase in cerebrospinal fluid volume. If this fluid increase is disproportionate, particularly if there is pressure on the ventricles and signs of brain edema, further diagnosis is needed to rule out abnormal pressure hydrocephalus. In such cases, a lumbar puncture may be performed to measure subdural pressure and release cerebrospinal fluid. If low pressure improves gait and cognitive response, a ventriculoperitoneal shunt surgery may be considered to restore normal cerebrospinal fluid circulation.

Ventriculoperitoneal shunt surgery is the most commonly used treatment for normal pressure hydrocephalus. The procedure involves a neurosurgeon implanting a small catheter into the brain's ventricles. This drainage tube is connected to a pressure regulator located beneath the scalp, allowing excess cerebrospinal fluid to be diverted and absorbed into the abdominal cavity through a subcutaneous pathway.

The regulator in the system can precisely adjust the pressure to maintain normal intracranial pressure. The shunt device can be permanently placed within the body and typically does not significantly impact the patient's daily life.

Normal pressure hydrocephalus is one potential cause of neurodegenerative dysfunction. If family members notice similar symptoms in a patient, it is important to seek medical attention promptly for further evaluation. Early diagnosis and treatment are crucial to avoid delaying recovery opportunities and to enhance the chances of effective management.