NPH diagnosis leads to treatment, relief for St. Luke’s patient; new program aims to help more patients

Anita Litteer could not continue to brush aside a feeling that something wasn’t right last year. So, she did the right thing – she called her doctor.

“I started feeling like I was losing strength and energy,” Litteer said. “I thought it was because I was getting older, but then it got really bad. My balance kept getting worse, and then I started falling.”

After an MRI, the results led her to the office of Dr. Edward Duckworth, the medical director for neurosurgery at St. Luke’s Health System.

Dr. Duckworth’s staff began a series of tests to see if Litteer was suffering from normal pressure hydrocephalus.

“When patients come into our clinic they go through pretty rigorous testing, so that we can determine if this looks like NPH,” said Jennifer Walls, St. Luke’s cranial program manager. “The diagnosis is complicated because it can look like other things, including Parkinson’s disease.”

NPH is a treatable condition that can mimic other forms of dementia, often causing difficulty walking, memory loss and bladder control issues. Because early and accurate diagnosis is key, St. Luke’s standardized evaluation process includes comprehensive outpatient assessments to determine the best course of treatment.

In fact, NPH is often misdiagnosed, because the patient’s symptoms can mimic other types of dementia, and other causes of imbalance.

“The trial we do consists of testing a patient’s walking speed, balance and cognitive function before a lumbar puncture test,” Walls said.

During a lumbar puncture, fluid is withdrawn to see if there is improvement in symptoms.

“What makes our program at St. Luke’s sophisticated is we have expert physical therapists and neuropsychologists who do a pre-evaluation and a post-evaluation,” Dr. Duckworth said.

Litteer’s pre-evaluation determined that she was a good candidate for the placement of a shunt to treat her NPH.

“The shunt, which is called a ventriculoperitoneal shunt, goes from the cavities in the brain, under the skin, to the belly cavity,” Dr. Duckworth said. “With NPH, the brain is stretched from the inside – almost like a balloon – from excess fluid. That interferes with memory, walking and urination.”

The placement of the shunt has proven to be extraordinarily helpful for Litteer.

“I talked to her afterwards, and she said she was walking faster and had gone back to driving,” Walls said. “She really had quite a bit of improvement. The urinary incontinence had also resolved and her memory was getting better.”

Dr. Duckworth said it’s especially satisfying to hear relatives express to him the improvements they see in his NPH patients after undergoing treatment.

“(People) will say, ‘My (spouse) is back,’” Dr. Duckworth said. “In Anita’s case … that’s a pretty big impact on a 75-year-old’s life.”