Recordings from the 2025 Neuro-APP Symposium-Helping Patients Dance Again

Video Transcription

Video Summary

The presentation reviews normal pressure hydrocephalus (NPH), a communicating hydrocephalus usually affecting older adults. Its classic symptom triad is “wet, wacky, wobbly”: urinary urgency or incontinence, cognitive slowing and decline, and a shuffling, unstable gait. Because these changes can be mistaken for aging, Parkinson’s, Alzheimer’s, or other conditions, clinicians should consider NPH and investigate alternative causes.<br /><br />MRI is preferred for initial imaging, while CT can help assess ventricular enlargement. When diagnosis is uncertain, a high-volume lumbar tap may be used, though its sensitivity is limited; a 24–72-hour lumbar drain trial can provide more thorough pre- and post-drainage assessments. The standard treatment is a programmable ventriculoperitoneal (VP) shunt, which diverts excess cerebrospinal fluid to the abdomen. Studies and clinical cases show meaningful improvement—especially in gait and bladder symptoms—and improved independence for many patients.<br /><br />Potential complications include infection, hardware malfunction, and over-drainage, which can cause subdural collections. Ongoing follow-up requires clinical assessment, imaging, careful valve adjustments, and patient education about shunt care, MRI compatibility, and abdominal procedures. During discussion, clinicians shared varied approaches to lumbar-drain trials, including drainage protocols and coordination with physical therapy.

Keywords

normal pressure hydrocephalus

NPH

communicating hydrocephalus

gait instability

urinary incontinence

cognitive decline

MRI imaging

lumbar drain trial

ventriculoperitoneal shunt