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    Are enlarged ventricles in NPH and enlarged ventricles in altzheimers same?

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Posted on Thu, 2 Jun 2016 in Brain and Spine
Question: Is there a difference between enlarged ventricles in NPH and enlarged ventricles in altzheimers?
doctor
Answered by Dr. Olsi Taka 44 minutes later
Brief Answer:
Yes there is.

Detailed Answer:
I read your question carefully and I understand your perplexity.

However generally it is easy to distinguish between the two atrophies. In NPH the ventricular enlargement predominates, it is disproportionate to atrophy of the sulci in the brain cortex, meanwhile in Alzheimers there is marked cortical atrophy as well (more pronounced of the temporal lobes).

Also in NPH there is not only the ventricular enlargement but also hyperintensities around the ventricles because there is passage of the cerebrospinal fluid (CSF) across. Additionally in NPH there can be found flow voids in the third ventricle and the aqueduct (dark areas in the midst of the bright CSF in T2 sequences - called also the jet sign).

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 25 minutes later
We are seeing a neurologist at this time and have been since December. According to the neurologist we are seeing, there are no physical signs of NPH. They have not made a diagnosis of Alzheimer's as yet, but have alluded to it. Along with the enlargement of the ventricles, there is also atrophy of the right hippocampus and left temporal and parietal lobe's. They have told us to go back in six months for reevaluation. I have my husband on a Alzheimer's diet, That was sent to me by that physician. MRA a of the head and neck are clear sleep study shows no apnea we are told he does have a mild cognitive impairment according to cognitive testing and memory isuues by myself and the patient.I feel this is leading to an Alzheimer's diagnosis. What is your take?
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Alzheimer's looks likely.

Detailed Answer:
Thank you for the extra information.

Based on that description of mild cognitive impairment with that type of atrophy, yes it does seem likely for it to be early stages of Alzheimer's.
Of course there are many causes to dementia, Alzheimer's is known because it's the most common one (about 50% of dementias).
MRI has excluded causes such as vascular issues or tumors. Some blood tests must be done to exclude metabolic causes like thyroid deficiency, vitamin B12 deficit (probably done already).
At the end of the day if blood tests normal, if there is cognitive impairment with that type of atrophy, I would say Alzheimer's is the most likely diagnosis.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 1 hour later
Blood tests are normal. What other tests should patient have to RULE INaltzheimers?
doctor
Answered by Dr. Olsi Taka 17 minutes later
Brief Answer:
Read below.

Detailed Answer:
In routine practice when there is the characteristic impairment of at least 2 cognitive domains in neuropsychological tests (1 domain should be memory), with a progressive course, normal imaging and routine blood tests then usually that is considered enough to make a probable diagnosis. A definitive diagnosis is made by autopsy only.
There are other tests which increase the accuracy of the diagnosis. They are not routine tests though, done more for research purposes. So whether you have them done or not depends on where you live, whether you have access to major centers who conduct these expensive tests.

Such tests include lumbar puncture and measurement of beta amyloid and tau protein in the cerebrospinal fluid (low level of beta amyloid and high protein tau is in favor of Alzheimer's). There is also brain imaging through PET (uses a radioactive trace which binds to amyloid plaques in the brain, characteristic for Alzheimer) or SPECT which may evidence decreased metabolism in temporo-parietal lobes. Such brain imaging is very expensive though and is reserved for research purposes mainly, to distinguish from rarer forms of degenerative dementia such as frontotemporal dementia, it is not used routinely.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 53 minutes later
You have been very helpful. Thank you.
doctor
Answered by Dr. Olsi Taka 1 minute later
Brief Answer:
You're welcome

Detailed Answer:
I hope things work out for the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

Neurologist

Practicing since :2004

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