Many older adults living with memory and cognition issues, an unsteady gait and bladder control problems might wonder if they’re signs of dementia or Parkinson’s disease. But these common symptoms of aging could actually be signs of a condition called normal pressure hydrocephalus, according to neurosurgeon Dr. Elizabeth Kuhn.

Estimates from the Hydrocephalus Association found that nearly 700,000 people have NPH, which stems from an undetected accumulation of cerebrospinal fluid in the brain. However, less than 20% of cases are properly diagnosed.

Kuhn_Elizabeth_1285044347_Head_web 1
Dr. Elizabeth Kuhn

Identifying NPH is a “huge barrier” to treating the disease, said Kuhn, a neurosurgeon specializing in NPH at Novant Health Brain & Spine Surgery – Kimel Park in Winston-Salem.

“With any medical diagnosis, we have a bias toward things that we know and understand well,” Kuhn said. “All of these symptoms are very common, and there are a million things that could cause them.”

In November, Kuhn joined Novant Health to help bring awareness of NPH and treatment for the disease.

When a series of tests confirms a patient has NPH, Kuhn can implant a shunt device in the brain. This minimally invasive surgery can offer patients quick relief and a higher quality of life.

Here, Kuhn explains what patients and their families can expect following an NPH diagnosis.

Complete neurological care.

Learn more

NPH diagnosis

Why is it challenging to diagnose NPH?

Normal pressure hydrocephalus is a buildup of spinal fluid that typically happens in older adults. It can be challenging for patients to get the right diagnosis because the symptoms NPH causes are nonspecific: Memory troubles, walking problems, difficulty controlling your bladder.

The way they teach it to us in medical school is ‘wet, wobbly and wacky.’ These are things that most patients go to their primary care doctor to treat.

NPH is challenging because there’s not one single test that can diagnose the condition. There’s not a lot of lab tests, especially at primary care practices, that can say, ‘Yes, you definitely have NPH.’”

Often, NPH is a diagnosis of exclusion. In other words, it’s putting together puzzle pieces requiring a series of tests to rule out other possibilities. But at the end of the day, treatment is pretty similar to other forms of hydrocephalus, a more generalized group of conditions characterized by a buildup of fluid in the brain.

NPH treatment

How is NPH treated?

NPH is treated by placing a shunt device from a patient’s brain to their belly that drains the buildup of excess spinal fluid.

A shunt is tubing implanted in the spinal fluid-filled areas of the brain that goes underneath the skin to the space around the belly. The intestines and the body reabsorb that fluid.

It’s a relatively straightforward procedure. It’s minimally invasive, just two small incisions. At first, a lot of people are intimidated when they hear “brain surgery.” But typically, patients stay one night in the hospital and are able to get back to pretty normal activities right away.

One of the things I want to do is dispel the fears and myths patients might have about what’s involved for treatment. There are pretty few risks to the surgery itself, and the potential for improvement is huge.

Best doctors. Amazing nurses. Remarkable care.

Read more here about our expert neurological care.

What is the recovery process for surgery to treat NPH?

Most of the time, patients see improvement right away. But not always. Sometimes it takes time for fluid to drain and the brain to recalibrate. Overall, recovery is just allowing the incisions to heal, which is about two weeks. After six weeks, patients can get back to normal activities without any restrictions.

Generally speaking, most people are candidates for surgery, as long as they have symptoms we reasonably think are related to NPH. Patients must be healthy enough to have an operation with general anesthesia.

Afterward, there really is an improvement. It gives them a lot of reassurance that they did the right thing.

How to get started

If you are having problems with walking, memory and bladder control, you might have NPH – talk to your primary care doctor. The first step is usually an office visit and detailed physical exam, blood work to evaluate for other common causes of these symptoms, and brain imaging (CT or MRI). Based on those tests, your primary care doctor can refer you to a neurologist or neurosurgeon for further evaluation and treatment.

Surgeon’s empathy is rooted in personal experience

Dr. Elizabeth Kuhn’s “aha moment” as a brain surgeon came when she realized mental health is just as important to a patient’s well-being as the brain’s physical condition.

That perspective is informed by her own experience with mental health challenges. In high school, Kuhn developed bulimia, an eating disorder marked by cycles of binge eating and forced purges to avoid gaining weight.

Bulimia’s root cause is psychological. For Kuhn, the disorder wrecked her confidence and shook her sense of self-image. She overcame the disease, in part, because her best friend at the time also suffered from the disorder. The two were able to confide in each other and relate about their experience.

Now, after graduating from Wake Forest University School of Medicine and beginning her career as a brain surgeon, Kuhn hopes to apply the lessons she’s learned in empathy to help connect with her patients.

“My experience gives me a different set of tools to talk about emotions and the way we process a new medical diagnosis or trauma,” she said.

In November, Kuhn joined Novant Health as a brain surgeon specializing in treatment for normal pressure hydrocephalus. The disease primarily affects older adults with symptoms including difficulty thinking and walking and loss of bladder control.

“Being able to address patients as a whole person and recognize their psychosocial and emotional needs is something I bring to the table,” Kuhn said. “While neurosurgery is my specialty, that’s only a piece of what a patient needs.”