Things Aren’t Always as They Seem
|Finis Fox savors every day and his daily ritual of checking the time on his collection of grandfather clocks.
When Garry Fox’s mother called him one day in late May to tell him his father, Finis, 83, couldn’t get out of bed, the family knew that the symptoms they had been observing over the last year had reached a critical point. “Dad had been having trouble walking and keeping his balance; he was sometimes confused; and his short-term memory was failing,” Garry recalls. “A CT scan done about a year ago had shown no abnormalities, so we thought we were seeing early signs of Alzheimer’s or maybe Parkinson’s disease – and we feared the inevitable outcome.”
After his mother’s phone call, Garry, who is a registered nurse at the Dayton V.A. Hospital, went to his parents’ Englewood home to assess the situation. “Concerned that Dad might be having a stroke,” Garry says, “we called 911, and the squad took him to the emergency department at Good Samaritan Hospital.”
Expertise Narrows the Options
In addition to stroke-like symptoms, Finis was also complaining about a pain in his back. Neurosurgeon Scott Glickman, DO, was called in to consult on the case. A CT scan of the brain showed no change from the scan taken a year earlier. “After examining Mr. Fox and given his history,” Dr. Glickman explains, “I suspected we might be looking at a case of normal pressure hydrocephalus (NPH) – a slowly progressing condition that can be disabling and difficult to diagnose. Finis was displaying some of the classic symptoms.”
Hydrocephalus – sometimes referred to as “water on the brain” – refers to a build-up of cerebrospinal fluid (CSF) in the ventricles of the brain. The body produces a certain amount of CSF each day; that same amount is absorbed in the brain. When an imbalance occurs, the ventricles enlarge to accommodate increased fluid volume, thus stretching the brain’s nerve tissue. Fortunately, unlike Alzheimer’s and Parkinson’s, NPH can often be treated and controlled.
Analyzing Every Clue
When excess CSF is removed, NPH symptoms temporarily improve. So Dr. Glickman performed an MRI and a high-volume spinal tap on Finis to confirm his suspicions. He found that, indeed, Finis was suffering from NPH. Placement of a shunt in the brain would achieve permanent improvement or resolution of Finis’s symptoms.
But Dr. Glickman suspected more: “NPH did not explain Finis’s back pain and lower extremity weakness. He had the classic type of pain caused by spinal stenosis, or narrowing of the spinal canal.” Finis’s MRI had also revealed a herniated disk and ligament overgrowth in his lower spine. After decompressing his spine and repairing the disc surgically, Dr. Glickman proceeded with the shunt procedure.
The shunt drains excess CSF fluid away as needed to maintain balance. The fluid moves via a one-way valve through a tube into the abdomen where it is easily absorbed by the body. The shunt’s valves are manufactured to operate at a specific pressure range. The surgeon chooses a pressure range for the shunt based on experience and the needs of the patient.
With his herniated disc repaired and a permanent shunt in place, Finis spent some time in a rehabilitation center before heading home. Although improvement often takes months, Finis is walking, with assistance, better than he was able to before surgery, and his mind is regaining its sharpness. As part of ongoing monitoring, Dr. Glickman has reprogrammed the shunt three times to fine tune its performance. “Finis’s prognosis for a full recovery is excellent,” he reports.
Diagnostics Make the Difference
|Dr. Scott Glickman
“Needless to say, we are tremendously grateful to Good Samaritan Hospital for the excellent care my father received,” Garry notes. “And we are grateful to Dr. Glickman not only for his skill as a surgeon but also for his diagnostic ability.
“My father’s symptoms were not that unusual for an older person,” Garry continues, “but Dr. Glickman saw the pattern. He looked beyond the ‘typical’ and changed dad’s life – and my family’s.”
In fact, Dr. Glickman recently performed surgery on Garry’s neck to relieve cervical radiculopathy (pinched nerve) and myelopathy (compression of the spinal cord) – but that is a story for another day. Today’s good news is that father and son are doing fine.
Diagnostics are a critical part of medical care. Symptoms – alone and in various combinations – are valuable clues to what is truly ailing a patient. A skilled diagnostician looks at patterns of symptoms to unlock medical mysteries not immediately apparent.
Normal pressure hydrocephalus (NPH) occurs most often in people over age 60. NPH has a constellation of three telltale symptoms, which often begin slowly:
- Changes in walking patterns, including a feeling upon beginning to walk that feet are glued to the floor, feet held wider apart than normal, shuffling, unsteadiness and sudden falls
- Slowing mental function including forgetfulness, loss of interest in daily activities, difficulty paying attention, and apathy
- Problems controlling urine (frequency and incontinence)
Learn more about how Good Samaritan helps patients resolve conditions affecting the brain and spine.