Normal pressure hydrocephalus: new complications and concepts

I am a complete fraud; an imposter. I am not a neurosurgeon. I am not even a neurologist! I am a retired hepatologist who has spent more than 50 years on the faculty at Yale University. The only truly noteworthy entry in my curriculum vitae is that I am both a Professor of Medicine at Yale and Professor of Surgery (clinical) at the University of Miami. Until four years ago I had never even heard of normal pressure hydrocephalus, which I shall refer to as NPH. I learned about NPH the hard way—I contracted it.

MY STORY

In 1993 at age 67 I had retired. Early in my retirement I began to have trouble walking. My gait was slow and awkward, and gradually over 10 years it worsened until I was unable to walk at all. I lurched from place to place. The Yale neurologist that I selected to care for me thought I had a Parkinson’s disease-like syndrome caused by cerebral atrophy. My brain MR scan showed both dilated ventricles and sulci (fig 1). Even after I had developed urinary incontinence, the neurologist still failed to recognise the diagnosis of NPH. Three other senior neurologists diagnosed a variant of Parkinson’s disease. I was unaware of any dementia. I thought that my loss of short-term memory was due to “old age”. My wife noted in her diary that I was not as sharp, as quick or as funny as I had been. The Yale neurologist persevered in his diagnosis of cerebral atrophy. After five years he called my wife and me into his office and told us that the cerebral atrophy had worsened and would probably continue to do so. He predicted that I would lose intellectual function. He told us that there was no effective therapy, nor would there be. We …