Evaluation
If your physician suspects you may have NPH, he should arrange for you to see a Neurosurgeon, preferably with substantial experience of this difficult condition. At the VCU Medical Center, Harold Young M.D., Chairman of the Department of Neurosurgery, looks after most of the cases of NPH. He is assisted by Anthony Marmarou Ph.D..
Initial Assessment and CSF Dynamics
The initial evaluation steps include a clinical consultation and examination, an MRI/CT scan, and commonly a CSF pressure dynamics test. This test can be done in the clinic simply, and safely. Briefly, a small amount of fluid is injected into the back, under local anesthetic, and the small pressure changes this causes are measured. From this test several complicated calculations can be made, which can both assist with confirming the diagnosis of NPH, and also with determining the specific type of valve which may be needed if your symptoms improve with External Lumbar Drainage.
External Lumbar Drainage
External Lumbar Drainage, is usually carried out at a separate hospital visit, over 3-4 days. On admission you will be very carefully assessed by experienced physicians. Your ability to walk will be measured and analysed using state-of-the-art computer-video analysis; your problems with continence will be assessed and quantified, and any disturbance in your cognitive processes will be evaluated by an experienced observer using objective tests. You will then have a volume of fluid drained from your back in order to reduce the amount of CSF around the brain. This is done very slowly, and is quite painless (although some people do develop a headache). After a couple of days of drainage, the same tests that were done when you arrived are repeated, and your response to the treatment is measured by the improvement in your symptoms. You will also then be followed for 10-14 days and asked to report your experiences, namely whether you feel better.
An improvement in symptoms with this procedure is highly suggestive that a CSF shunt procedure would be beneficial for you. If your symptoms remain the same or slightly worsen after this drainage, this is a strong indication that an operation would not be of any help.