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A Missed Diagnosis

Yesterday, my father sent me a clipping someone had given him from the Wall Street Journal.  (Unfortunately, I don’t know what the date of publication was.)  The article spoke about several health conditions that can mimic Alzheimer’s disease, and are often misdiagnosed as such.  One example in particular got my attention.

The article highlighted the case of a man, 70 years of age, who began showing memory and movement problems 13 years ago.  Three different doctors diagnosed him as having Parkinson’s disease and, when he didn’t respond to prescribed medication, ordered more and more drugs.  Other people speculated that he had Alzheimer’s.  Then, last year he saw a neurologist who did an MRI followed by a spinal tap.  He discovered that what the gentleman had was something called normal pressure hydrocephalus, an abnormal build-up of fluid in the brain.  A shunt was surgically implanted, and a miraculous transformation occurred.

A study of 147 nursing home residents, in 2007, showed that 9 to 14% showed possible signs of normal pressure hydrocephalus.  This disorder can be deceptive, because it generally develops quite slowly over a long period of time.  This is unlike other forms of hydrocephalus that result from an injury, for example,  where symptoms develop rather suddenly.  Because of this, the condition is often misdiagnosed as Alzheimer’s or vascular dementia.  Most typically, these people show memory problems, an unsteady gait, and urinary incontinence.  The presence of the abnormal cerebrospinal fluid in the brain, usually seen as enlarged ventricles, can be found through an MRI.  A spinal tap will usually show if the person’s symptoms improve somewhat, and then surgery can be done to re-direct the fluid.  As a result, the person’s function will generally improve quite significantly.

Experts stress that this is an area that needs careful consideration before subjecting a person to surgery.  Even though normal pressure hydrocephalus is very much an under-diagnosed condition, it still only accounts for probably less than 10% of all persons with dementia.  But this story shows that we should not be afraid to ask for an MRI, or other brain imaging tests, to confirm a diagnosis.

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  1. September 18, 2012 at 5:03 PM
  2. January 16, 2013 at 7:47 PM

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