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   Miami Herald | MiamiHerald.com   
      
   Health & Fitness  AUGUST 21, 2015   
      
   "Water on the brain" could be misdiagnosed as Alzheimer's   
      
   BY JENNY LUNA   
   jluna@miamiherald.com   
       
       
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   When an 84-year-old woman starts to lose her balance, has trouble walking or   
   forgets details from last week or last year, common thought says she's showing   
   early signs of Alzheimer's disease, perhaps Parkinson's, or is just   
   experiencing the normal    
   decline that comes with aging.   
      
   That's what Ronald Pallot figured was happening to his wife Gloria. Pallot   
   moved quickly to keep up with his wife's rapid decline: He put walkers in   
   their apartment in Aventura and got Gloria a wheelchair. He led her to the   
   kitchen, to the bathroom and    
   didn't schedule as many social engagements. He figured her loss of personality   
   was a sign of dementia.   
      
   "We thought, 'This is what it is, we're going to live the way it is,'" Pallot   
   said. "But it kept declining."   
      
   That is until Gloria had brain surgery three years ago. Now 87, she no longer   
   needs Pallot to help her around their apartment, and she can carry on a   
   conversation about current events.   
      
   Gloria falls into the category of those suffering from normal pressure   
   hydrocephalus, a condition caused when an excess of brain and spinal cord   
   fluid puts pressure on brain tissue. Hydrocephalus gets its name from the   
   Greek language: "hydro" meaning    
   water and "cephalus" meaning head, though the variety of symptoms and   
   conditions under the umbrella term vary widely. The condition, commonly   
   referred to as "water on the brain," occurs in children and adults and can be   
   congenital or acquired. Normal    
   pressure hydrocephalus, the kind Gloria suffered, differs greatly from the   
   condition in infants or children, which progresses in patients more rapidly   
   and is treated differently.   
      
   For patients like Gloria, symptoms set in over a long period of time and   
   mirror those commonly associated with old age--memory loss, trouble going from   
   standing upright to walking and loss of bladder control. A problem occurs when   
   families begin    
   preparing for their loved one's decline, said Dr. Allen Krantrowitz, chief of   
   neurosurgery at Mount Sinai Medical Center in Miami Beach, when they could   
   have a treatable condition.   
      
   "It's an ageism issue," said Kantrowitz. "If one simply accepts the idea that   
   with age comes slow cognitive decline, and you don't challenge and ask   
   questions about why it's happening, then you'll never identify those treatable   
   causes of early onset    
   dementia."   
      
   Alzheimer's and Parkinson's diseases aren't treatable, but normal pressure   
   hydrocephalus is. To rid the pressure on brain tissue, neurosurgeons can   
   insert a small plastic shunt into the brain that drains the excess fluid into   
   the abdomen, where it can be    
   safely absorbed. Gloria went to Mount Sinai for the operation, and Pallot said   
   it was just after the anesthesia wore off that he noticed his wife's   
   improvement.   
      
   "She became more conversational; she seemed more alert," Pallot said.   
      
   "He put the shunt in and that was all," Gloria remembered. "I'm 100 percent   
   better."   
      
   But shunt insertion isn't done as much as it could be, said Kantrowitz. He   
   wants to educate families and primary physicians about this option that may   
   not be an easy decision to make, but often is the only one.   
      
   "Mostly when we think about brain surgery, we see it as a last resort. But for   
   patients with hydrocephalus, they welcome the procedure," Kantrowitz said.   
   "When you're first told there's nothing you can do but prepare for your   
   decline, the thought of a    
   surgery that will actually reverse symptoms comes as a warm welcome."   
      
   It is estimated that 375,000 older Americans have normal pressure   
   hydrocephalus, though the number may be greater due to misdiagnosis. The   
   Pallots said they were "skeptical" at the thought of brain surgery because   
   there is no definite test that confirms    
   or denies the condition.   
      
   It took nearly a year for Gloria and Ronald Pallot to weigh their options   
   before they had "everything to gain and nothing to lose."   
      
   One test, called a lumbar puncture, can relieve some of the built-up pressure   
   on the brain for a few days but may not be long enough for patients to come to   
   a conclusion that symptoms are indeed caused by normal pressure hydrocephalus.   
      
   Kantrowitz also said that risks are much less than they used to be.   
   Developments in recent years have made inserting shunts safer for patients.   
   Just as GPS systems allow pilots to locate runways 20,000 feet in the sky,   
   similar technologies allow    
   neurosurgeons to pinpoint the exact location to insert the shunt. The plastic   
   valves are adjustable in size, and if a patient's symptoms return, a small   
   adjustment to the shunt's width can quickly address the problem.   
      
   The Pallots are back to going to dinner with friends, and Gloria no longer   
   uses her walker to get around the house. She's back to normal life, she said.   
      
   Follow @J2theLuna on Twitter.   
      
   2015 HYDROCEPHALUS ASSOCIATION WALK   
   When: 10 a.m. Nov. 7, Quiet Waters Park, Shelter #10, 401 S. Powerline Rd.,   
   Deerfield Beach, 33442. Check-in begins at 8:45 a.m. Participants should   
   register in advance.   
      
   For more information, email Angelica Haymore at southFLWALK@hydroassoc.org or   
   call 954-661-5247.   
      
      
      
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