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How to improve the function of brain for absorbing excess CSF?

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Dr. Ganesh Sanap

Radiologist

Practicing since :2007

Answered : 561 Questions

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Posted on Thu, 10 Jan 2013 in Brain and Spine
Question: Sir,

I cannot believe that there is only one treatment for NPH. I.e. Shunt.

Why we cannot have a further research on how we can improve the function of brain for absorbing excess CSF. why the system failed in the first place? Why its is irreversible?

Shunt have its own complications and in old age like 75-80, many will want to avoid surgery of sensitive organ like brain. Too risky it occurs. Placebo may not work well in spite of your high authority in doing shunt.

Dont limit yourself to your area of practice. I would love to hear from you if you can tell us more about what research are going on around the world on this.
doctor
Answered by Dr. Ganesh Sanap 3 hours later
Hi,

Thanks for writing to us. My comments are as follows:

1. CSF is produced in ventricular system of brain in choroid plexus and absorbed in the spinal cord at arachnoid villi. It is very important to have proper balance between these two processes. Any imbalance causes hydrocephalus.

2. Acetazolamide (Diamox) has been used for short while to treat hydrocephalus. However on long term medical drugs has not been able to significantly modify the functions of the above mentioned cells. Therefore surgical management is the treatment of choice as there are no medical drugs to modify the functions of the above mentioned cells.

3. Of the various surgical methods, VP shunt is the most widely performed one. Unfortunately there is failure of VP shunt in few cases. It occurs due to blockage or malposition at time of placement. In addition if VP shunt was performed in early life, increase in height causes VP shunt stretching and displacement.

4. Apart from VP shunt, in a few obstructive type of hydrocephalus, putting stent directly in the brain between ventricles is the only other effective option to treat it.

Hope I have answered your query. Any follow up questions are welcome.

Regards

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ganesh Sanap 30 hours later
Hi,

My father who is 75 yrs old and have NPH symptoms, He is taking Nootropil 800 twice a day (Piracetam). He was never on Acetazolamide (Diamox).

He is also taking Thyronorm 62.5 mg. Other blood thinning and blood pressure drugs are on. He is also taking some vitamins and calcium tabs as suggested by our physician.

We recently showed him to a psychiatrist for auditory hallucinations and confusions. He is now also taking Quitipin 0.25 - 0 - 0.5 and Serenace 50 mg

We have done is MRI 3-4 years back. His lumber puncture 3 years back did not provide us a clear clue.

His CSF test (18-08-2010) results are as follows
Physical Examination -7ml, colorless, clear, cobwebs absent
CSF glucose - 56 ( range 45-100 mg/dl)
Protein in Mg % - 88 ( Range 15-45 mg/dl)
Chloride 123 (Range 110-130 mEa/L)

WBC per cum mm - No cells seen
RBC per cum mm - occasional

No organism seen - Acid fast baciili not seen
No other test of CSF conducted. Then neurologist forgot some culture test of CSF and only routine test as above conducted

His walking and speaking deteriorated. Some confusion and mind talks. Urinary incidence etc

Suggest.
1. Is it a time again to see new neurologist or neurosurgeon or both
2. New MRI is needed?
3. New Lumber puncture and CSF test needed?
4. How we know this is a case for shunt?
5. Cannot we have little betterment in his condition thru medicines?




doctor
Answered by Dr. Ganesh Sanap 3 hours later
Hello Mr. XXXXXXX
Thanks for writing back.
It doesn't look like an infection in the brain. That's why no need for culture and sensitivity of organism.
Yes, it is the time to consult neurophysician again. If it's clinically indicated, then MRI examination needs to be repeated.
Since your father is on multiple medications, his present complaints may be a side effect of drug due to dose adjustment. New therapeutic procedures can be decided only after repeat test, at least MRI and lumbar puncture.
Considering the age of your father, operation is not first choice. It can be managed by multiple lumbar punctures. But the final decision is upto your physician. Medicine will help but does not have a definitive role in such conditions.
Hope I have answered your query. If you have any more concerns, please let me know.

Regards .
Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
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Follow up: Dr. Ganesh Sanap 23 hours later
Thanks.

I want to know one more thing. Are multiple lumber punctures safe? How many days the benefit of a lumber puncture will stay as new amount of CSF will be produced again by the body.

Thanks Again.

Regards,
XXXXXXX
doctor
Answered by Dr. Ganesh Sanap 1 hour later
Hi XXXXXXX
Thanks for writing back.
Multiple lumbar punctures are safe. But the doctor should be expert in the procedure and conditions during the procedure must be highly sterile to avoid infection.
Effectiveness of lumbar puncture depends on the disease process as such. It quite difficult to make generalized statements
Thank you.
Above answer was peer-reviewed by : Dr. Aparna Kohli
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