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You wrote: > >This message is to Dr. Bob Fink in particular, and to anyone else who might >have suggestions. I'm a novice here, and not sure about the protocol for >posting public messages. > >Dr. Fink: On 1/27th you wrote that "normal pressure hydrocephalus" can also >cause PD-like symptoms and can be ruled out with a CT scan. > >Could you elaborate? What is 'normal pressure hydrocephalus'? What might >treatment be if this condition exists? > >You wrote in response to the dialog about my 76 yr old father who has a >lifelong condition of Essential Tremor (Familial Tremens) and recent guarded >diagnosis of PD. > >I say guarded because the neurologist expressed some uncertainty but >prescribed Sinemet at my father's persistence. He has been taking the >Sinemet for 6 months (in addition to propanolol) and seems to have better >balance. Otherwise I am having difficulty detecting significant change. > >"Leg lock" and muscular weakness are his most frequent complaints. His arm >and hand tremor is almost violent at times. > >Getting my dad to see a physician is a tremendous ordeal - physically and >emotionally. He has little confidence that modern medicine can help him. My >guess is that getting him a CT scan would be nigh impossible. > >Thanks for any responses. > >Val Mitchell >[log in to unmask] > > Val: Normal pressure hydrocephalus (NPH) is a condition that is characterized by: 1. Dementia 2. Gait disturbances (often Parkinsonian-like) 3. Urinary incontinence Some of the symptoms are indistinguishable from those of PD. The diagnosis is made by CT (or MRI) scan which shows enlargement of the brain ventricles out of proportion to any brain atrophy present. This test is followed by a "cisternogram" in which a radioactive isotope is injected (through a spinal puncture) into the spinal fluid, and then a series of scans are taking over a 48-72 hour period. In NPH, the isotope penetrates the ventricles but does not rapidly leave the system (as is normal). The treatment of this condition is a surgical procedure called a shunt, which places a small tube into the ventricle, and conducts it into the abdominal cavity (all of the hardware is under the skin and the operation is relatively simple) where it is re-absorbed. The results can be dramatic in the form of reversal of the dementia, gait disturbances, and other symptoms. This operation is a fairly "standard" one and is available wherever neurosurgeons exist. The essential part, however, is making the diagnosis. Anyone with dementia, or other progressive neurological symptoms, deserves such an evaluation. The CT/MRI scans are painless, and the spinal puncture (for the cisternogram) is minimally uncomfortable in good hands. Good luck! Best, Bob -- ******************************************************** Robert A. Fink, M. D., F.A.C.S. Phone: 510-849-2555 Neurological Surgery FAX: 510-849-2557 2500 Milvia Street Suite 222 Berkeley, California 94704-2636 USA E-Mail: [log in to unmask] CompuServe: 72303,3442 America Online: BobFink "Ex Tristitia Virtus" ********************************************************