Why Normal Pressure Hydrocephalus (NPH) like Billy Joel's is so hard to diagnose
This is a disorder of the Cerebrospinal fluid (CSF) secreted in generous quantities from the two cavernous ventricles within the brain from where it circulates over its surface and down the spinal column before being reabsorbed. Its diverse functions include, variously, nourishing the tissues with which it is in contact, keeping the brain buoyant within the bony skull, and acting as a 'shock absorber' protecting it from traumatic injuries to the head.
The precise mechanism of NPH is not known, but it is probably due to partial obstruction of the flow of the fluid around the brain so it accumulates within the ventricles, causing them to enlarge, thus compromising the function of the neuronal circuits in close proximity. Hence the impaired mobility – an abnormal shuffling gait as if the feet are 'glued to the ground' – and the cognitive impairments characteristic of mild dementia: forgetfulness, poor concentration, changes in personality and behaviour and so on.
Logically then a surgical procedure that drains the excess fluid from the ventricles should, by allowing those adversely affected neuronal circuits to recover, result in a marked improvement. As indeed it may. But that of course presupposes making the diagnosis in the first place, which is problematic on several counts.
NPH is frequently overlooked
The gradual insidious onset may too readily be misattributed to the normal process of ageing where some degree of impaired mobility and cognitive decline is unexceptional. Then by the time the symptoms are severe enough to warrant medical attention, there is a high probability they may be due to some progressive neurological disorder (such as Alzheimer's) so other possible explanations are not pursued. And while one might expect an MRI scan would show the ventricles to be enlarged, the findings can be ambiguous, especially in the early stages, and require further confirmatory specialist tests.
The upshot being that NPH as a remediable cause of cognitive decline is almost certainly commoner than might be supposed and frequently overlooked. This is well illustrated by the cautionary experience of a reader who was advised his mother's deteriorating mental state was due to a series of 'mini strokes' and it would be best to place her in a nursing home and 'get on with the rest of my life'.
This he was most reluctant to do. Soon after she fell and broke her arm, requiring a further stay in hospital 'where the doctors all tried to reconcile me to coming to terms with my mother's worsening dementia'.
Instead he sought a second opinion privately from a neurologist who picked up on the two important clues that her mental decline had coincided with her gait becoming unsteady (hence the broken arm) and also urinary incontinence (a further 'late' symptom of NPH) – attributed by her GP to cystitis, but which had not responded to treatment with antibiotics. Further investigations confirmed she did indeed have NPH. Following the procedure to drain the excess fluid from those expanded ventricles she has made 'virtually a complete recovery'.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Daily Mail
an hour ago
- Daily Mail
Dire wolves brought back from extinction have already doubled in size, new video reveals
Dire wolves vanished more than 12,000 years ago but science has brought them back, and now, the massive creatures made famous by Game of Thrones have doubled in size in mere months. Romulus, Remus, and Khaleesi, the first genetically engineered dire wolf pups, are growing bigger than most gray wolves. The dire wolves were created by Colossal Biosciences, a Texas-based company using cutting-edge genetic engineering to bring extinct species back to life, including the woolly mammoth, dodos, and Tasmanian tigers. In a newly released video, the team revealed that Romulus and Remus, the two male pups, are now over six months-old and weigh more than 90 pounds each. That is about 20 percent larger than a standard gray wolf, making them the closest thing to a real-life dire wolf in more than 10,000 years. Romulus and Remus were born last year on October 1, while Khalessi was born earlier this year in January, making her the youngest of the pact. In the video uploaded by Colossal, the two male pups were seen running and playing together, chasing each other, and showing friendly behavior which reflects healthy social bonding. They seemed comfortable in their new outdoor surroundings after leaving the lab. Matt James, Chief Animal Officer at Colossal, said: 'They're nice large wolves that are much more representative of what we saw in the ancient specimens.' The pups are now getting ready for their first full medical checkup, which will include CT scans and blood tests to study their bones, muscles, and internal growth. Scientists say these physical changes, like their unusually large size, show that the dire wolf genes engineered into their DNA before birth are now actively shaping their development. The team also gave an update on Khaleesi, the only female of the trio, describing her as 'a little smaller, a little younger.' According to researchers, the female wolves are naturally smaller and tend to grow at a slightly slower pace compared to males. 'She currently weighs about 35 pounds, but is still tracking about 10 to 15 percent larger than what we have seen in gray wolves,' James said. Khaleesi is being kept separate for now to ensure she's big enough to safely join her older brothers. The team is carefully watching her growth before moving to a gradual, staged introduction. In the video, James described the pups' growth as impressive, noting they have hit all expected milestones for development. Currently, the pups are eating an adult diet of a high quality dog kibble, game-grade ground meat, and bones to help them develop hunting instincts. Paige McNichol, manager of animal husbandry at Colossal, said: 'Remus is really taking that alpha role, and Romulus is stepping down and being more subordinate in the pack.' Although Remus is slightly smaller than Romulus, he's proving to be more dominant. He's constantly watching his surroundings and thinking before acting, a behavior McNichol described as crafty and calculated. That makes him more of a strategic leader, while Romulus, though physically larger, tends to charge ahead first but follows Remus's lead during interactions, a classic behavior among beta males. 'This dynamic may change as they grow, especially when their younger pack mate Khaleesi is introduced,' McNichol said. The team is carefully and slowly introducing her to Romulus and Remus, starting with visits through fences. 'We're looking for really strong indicators that they are socially compatible,' said James. The eventual goal is to release all three onto a private preserve where they can live as a functioning pack. Six months ago, Colossal made headlines when it first announced the births of Romulus, Remus, and Khaleesi, claiming to have 'brought back' the dire wolf. The animals, made famous by Game of Thrones, last roamed North America more than 12,000 years ago before going extinct. These pups are lab-made hybrid wolves. They are genetically modified gray wolves, engineered to revive the ancient predators using advanced DNA-editing tools. Scientists compared the ancient dire wolf's DNA to a gray wolf's, identifying 14 distinct genes. They made 20 changes in gray wolf to match the dire wolf's DNA, resulting in larger, more resembling wolves. Nic Rawlence, an associate professor and director of the Otago Paleogentics Laboratory at the University of Otago, told 'To truly de-extinct something, you would have to clone it.' 'The problem is we can't clone extinct animals because the DNA is not well enough preserved,' he said. The process started by extracting ancient DNA from fossils and comparing it to the gray wolf's DNA. Scientists then made changes into gray wolf's DNA to mimic the dire wolf, and then they implanted it into a surrogate mother, giving birth to a genetically made dire pup. Romulus, Remus, and Khlaessi were born using this method, which Colossal calls part of its 'de-extinction toolkit.' The company says that their broader plan is to correct past ecological damage caused by human activity, including overhunting and habitat destruction. 'We're committed to rectifying the past and rehabilitating nature on a global scale,' the company's website states. Experts have warned that creating large carnivores, even in captivity, could have unintended consequences. Between 2002 and 2020, there were 26 reported fatal wolf attacks on humans globally, according to the Norwegian Institute for Nature Research. 'If released into the wild in large enough numbers to establish a self-sustaining population, this new wolf could potentially take down prey larger than that hunted by gray wolves,' said Rawlence. He also warned that if these lab-made hybrid wolves were to breed with wild populations, their altered genes could spread, disrupting ecosystems. For now, the team says the final size is uncertain, but they are looking for signs that the pups may continue growing toward the size of their ancient counterparts. Historically, extinct dire wolves stood about three feet tall at the shoulder, reached lengths of up to six feet, which makes them 30 to 40 percent heavier than today's gray wolves. Fossil evidence suggests they could weigh between 130 and 150 pounds, according to the National Park Service.
Times
an hour ago
- Times
How accurate is Jurassic World Rebirth? The palaeontologist's verdict
This is a fun, nostalgic adventure. The palaeontologist Dr Loomis (Jonathan Bailey) encapsulates what many of us are like. There is love, passion, genuine awe and, yes, a little nerdiness. I like how emotional he becomes when he touches a dinosaur for the first time — I'd feel the same. There are a few things that aggravate. For instance, mosasaurs and pterosaurs are not dinosaurs, although they're discussed as such. They are prehistoric reptiles, which swim and fly respectively. But I did like the design of the mosasaur. Although far larger than any fossil yet found, the anatomy was more accurate than in the previous films. The quetzalcoatlus (a type of giant pterosaur) was covered in fuzzy, hairlike structures that match the fossil record. • Every Jurassic Park movie ranked — from worst to best A lot of thought has gone into drawing on the science and developing the behaviour of some of these creatures. The co-operative hunting behaviours between the mosasaur and the spinosaur was a neat idea taken from modern animals. I was initially sceptical of another mutant storyline. The film-makers could have used other amazing prehistoric species — such as the giant ichthyosaur, Ichthyotitan, which I named in 2024 and which was as big as the on-screen mosasaur — rather than creating new mutants, but it does echo the original novel and movie. After all, these creatures were genetically engineered, with missing DNA filled in from other animals such as frogs. Inevitably you're going to get oddballs. • Read more film reviews, guides about what to watch and interviews Their accuracy is often criticised, but the Jurassic Park films have done so much for palaeontology and brought dinosaur science to new audiences. I'm always going to want it to evolve rather than become extinct. The Secret Lives of Dinosaurs by Dr Dean Lomax (Columbia University £32 pp312) is published in September
The Guardian
2 hours ago
- The Guardian
Carbon-capture plan may be self-defeating
The carbon-capture process described in your article uses lime pellets (Shipping is one of the world's dirtiest industries – could this invention finally clean up cargo fleets? 26 June). These are typically produced by heating calcium carbonate (limestone), releasing CO2 and requiring large amounts of energy, producing yet more CO2. If the used pellets are heated in a kiln for reuse, even if with renewable energy, the captured CO2 is released again and nothing is gained. Quicklime production creates yet more CO2, so without removing these emissions, Seabound's process would make shipping even dirtier. The Inflation Reduction Act passed under Joe Biden is funding development of cement production from calcium silicate. Once turned into concrete, this process sequesters CO2 overall, and in even larger amounts if green electricity fuels the kilns. Seabound should take note, else their technology is just another carbon-capture con. Wind turbines are turned off when too much electricity is being produced, and, bizarrely, we pay to turn them off. This excess could fuel kilns instead as well as the production of hydrogen for steel furnaces. Small nuclear reactors, as used in nuclear submarines, could also fuel energy-hungry kilns and furnaces. Vitrified nuclear waste could be put into deep-ocean subduction-zone trenches in the casings of US bunker-busting bombs or fired at the sun when Elon Musk's Starships stop auto-dismantling, rather than wasting these rockets on the futile race to Mars. Blue-green algae sequestered vast amounts of CO2 over 2bn years; now mankind is busy releasing it again over a few decades. We had best harness these little helpers and farm other CO2 fixers such as mussels, clams and oysters, if we wish to sequester CO2 in an environmentally safe Richard RichardsBrant Broughton, Lincolnshire Have an opinion on anything you've read in the Guardian today? Please email us your letter and it will be considered for publication in our letters section.
