Normal pressure hydrocephalus by definition is a middle age disorder. How can we be sure of this agreed scientific fact?
Another possibility is that it started much earlier and have been diagnosed when fulminate.
I would surely answer any question which I have its knowledge and expertise to answer it and to help others. I believe that research gate is started for this reason
There are several examples of NPH, such hydrocephalus follwing subarachnoid hemorrhage, or occurring as a consequence of mild infections of CNS, which have a certain causal factor and also a certain moment when the process leading to its development started. In these cases an undiscovered longstanding CSF disorder can be ruled out. In other cases of so-called "idiopathic" NPH where neither the causative factor nor the moment of the beginning of the pathological process are determined, this certainily can be so! And this is an attractive hypothesis which should be studied further.
Thank you too much Dr Aldo for your response and giving very good summary of the problem. Hydrocephalus many times may be very difficult to diagnose. Among many neurosurgeons SHYMA clinical picture of hydrocephalus is not well recognized. Also hydrocephalic patients might not go to neurosurgeons and consult many other specialties. Very rarely CSF disorder will be thought of. Many cases can be missed to be recognized very late presenting with Hakim Triad. So we should not stuck to this triad and make strategies to avoid missing these cases and to diagnose it earlier. We should of course care of all kinds of patients with different brain pathologies, but hydrocephalus is having the great advantage of potential reversibility
The physiopathogenesis of the NPH is still unknown, and we are usually investigating for an intracranial cause. I have a feeling that the problem may be outside the intracranial compartment, e.g. a higher resistance to the CSF passage to the spinal subarachnoid space. Thus, a study needs to be done evaluating both diastolic and systolic volumes of the intraspinal subarachnoid space.
Thank you Dr Marcelo. I am not an expert to comment on your hypothesis. But on following your publications I noticed that you are an interested researcher. One of your many papers was related to characterization of migraine compared to tension headache. In hydrocephalus and specifically in intracranial hypertension, headache characterization is vague in literature. I passed through a very unique experience on passing through about 15 CSF levels feeling what happens. Characterization of headache in hydrocephalus is a potentially key point in diagnosis and management. How can you help or direct us in this point as a researcher ?
Kindly keep a rapport between us going on until we come to practical useful points in this important direction.
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