Hydrocephalus awareness week gives us the opportunity to raise awareness about hydrocephalus and explain common misconceptions about it. Misdiagnosis is always a danger in medical practice and adults developing hydrocephalus later in life are in risk of their diagnosis being missed or confused for other conditions with similar early symptoms like dementia.
What is Hydrocephalus?
Hydrocephalus involves the build-up of excess fluid within the brain which raises pressure inside the skull and can ultimately cause damage.
Adults can develop hydrocephalus following a traumatic event like a brain injury, a stroke, or a serious infection like meningitis. These conditions can cause spaces inside the brain (ventricles) to get bigger and fill with too much fluid or they can get blocked where the fluid would normally drain away. Because the condition develops after birth, is called acquired hydrocephalus. Because the nature of the event that triggers acquired hydrocephalous is usually traumatic, it is not often misdiagnosed. The same tests clinicians would order to diagnose the original cause of the brain injury should also show the development of hydrocephalus.
Normal pressure hydrocephalous (NPH) is also a form of adult-onset hydrocephalus which is more frequently misdiagnosed. The cause of NPH is often unknown and usually affects people over 60 years of age. The reason the condition can be missed is that early symptoms are often similar to other conditions like early onset dementia or Parkinson’s disease. GP’s and other clinicians therefore do not always think of NPH as being a potential cause of symptoms. It’s important to raise awareness of this condition to ensure that it is picked up early.
The good news is that when diagnosed on time, hydrocephalus is treatable.
Misdiagnosis of adult Hydrocephalus
Distinguishing between the early symptoms of early-onset dementia and normal pressure hydrocephalus (NPH) can be difficult, as they share some similar features. Both conditions can manifest with cognitive decline, including memory problems, difficulties with decision-making, and slowed thinking. However, a key differentiator lies in the presence of changes to the ways a patient walks and moves their feet as well as urinary incontinence, which are common symptoms of NPH but not of dementia. While early-onset dementia primarily focuses on cognitive changes like memory decline and general confusion, NPH often presents with a noticeable shuffling or unsteady way of walking, alongside increased urinary urgency or incontinence. Therefore, while cognitive decline is a common thread, the presence of distinct motor and bladder control issues strongly suggests the possibility of NPH, making a comprehensive neurological evaluation crucial for accurate diagnosis.
Through our work we have represented a number of clients whose NPH diagnosis was significantly delayed because their treating doctors focused their investigations on other neurological conditions like dementia. Apart from the close resemblance of the cognitive symptoms another important issue is the general lack of awareness of NPH compared to conditions like Alzheimer’s and dementia and the fact that NPH is more common in older adults, a population already at risk for various forms of dementia.
Why is a quick diagnosis important?
Accurate diagnosis is very important because NPH is one of the few causes of dementia-like symptoms that can be effectively treated. The standard treatment involves the surgical placement of a shunt to drain excess fluid from the brain. Early intervention can significantly improve symptoms and enhance the patient’s quality of life.
To diagnose the condition it is important to have a thorough neurological examination that assesses movement, cognition, and bladder function. Brain imaging (such as MRI scans), is crucial for revealing visual signs of NPH. There are other tests such as spinal taps, which can help determine if drainage of cerebrospinal fluid (CSF) improves symptoms, indicating that the patient may benefit from having shunt surgery.
As set out above, raising awareness among healthcare professionals and the public is crucial to reducing misdiagnosis. By recognising the signs and symptoms of NPH, we can ensure that individuals receive timely and appropriate treatment, potentially reversing their cognitive decline and improving their overall well-being. While early-onset dementia presents a significant challenge, it is important to remain vigilant and remember that other treatable conditions, such as NPH, can mimic its symptoms. Thorough evaluation is key to ensuring accurate diagnosis and optimal patient outcomes.
How we can help?
A missed or delayed diagnosis of hydrocephalus can have a life changing impact on the life of a patient and their loved ones. Untreated hydrocephalus is dangerous and can lead to further brain damage. A correct diagnosis and treatment can prevent many of the symptoms that stop patients from living a normal life and help them return to what their lives were before they manifested the condition. A correct diagnosis of NPS can also lead to the diagnosis of the underlying condition that led to it.
If you or a loved one have been affected by a delayed or missed diagnosis we can help you. To have a free, confidential discussion with a member of our team call us today on 0800 044 8488 or fill in our contact form so we can call you back at a time convenient for you.
Enable Law are partners with Shine, the spina bifida and hydrocephalus charity. The charity has a wealth of resources and practical support in place for children and adults diagnosed with hydrocephalus. If you want to understand more about the condition or reach out to them for support visit Shine – Spina Bifida & Hydrocephalus.
