Q: My 73 years old father is suffering from normal pressure hydrocephalus (NPH). Is surgery necessary to treat this? What are the risk factors involved? Please advise.

A:Hydrocephalus implies abnormal collection of water-like cerebrospinal fluid within the cavities of the brain. It commonly follows obstruction to the normal flow of this fluid in or around the brain. When it occurs in the elderly, it does not cause symptoms or signs of increase in the pressure within the skull, hence is termed normal pressure hydrocephalus (NPH). It is suspected in patients who show progress diminution in enthusiasm for life, develop disinterest in activities they were earlier keen on and show difficulty in walking with a slow, short-stepped gait that makes the observer wonder whether the patients feet are glued to the ground. In later stages the patient is bed-ridden and loses control over the passage of urine and stools. Diagnosis is usually made on a combination of clinical features and those on CT cisternography. During the latter test, a radio-opaque chemical is introduced in the cerebrospinal fluid in the lower back and its flow tracked by serial CT scans over the next 48 to 72 hours. In patients with NPH, the chemical enters the cavities of the brain and remains there for 24 to 48 hours or longer. Once the diagnosis is made it is advisable to insert a valved tube termed a shunt to drain the cerebrospinal fluid away from the brain continuously. In many patients there is a slow but steady improvement that is truly gratifying to family and surgeon.