A Different View
SPECT: Single Photon Emission Computed Tomography putting the T in SPECT Brain Imaging.
Lake Michigan
The Tomographic View: The operational word for this post is Tomography… these slices make a difference for NPH: Normal Pressure Hydrocephalus – see the “TV Commercial” [showing the typical gait] at the bottom of this page and I’ll tell you a brief story about the one, the NPH one, that almost got away.
This is a shot of what I saw on [many] tomographic views/slices provided by the patient for the second opinion. The surface 3-D renderings, looked actually quite good – but looking at the slices, the inside of the brain, there was another story.
Take a quick look at this brain sliced tomographically with SPECT imaging, and see if you see what immediately came to my attention: Those blue areas in the center simply shouldn’t look like this: these pictures are the blue holes of swollen ventricles, on multiple levels, multiple slices.
Clinical Findings
But let’s start at the beginning: Chief Complaint in this 65 yo male: memory deterioration, long standing ADD symptoms recently worse, no head injury, and, yes, some clear metabolic problems… – but the big finding in the tomographic slices – big holes in the center of the brain, where the ventricles have swollen and ballooned out. Those blue areas are the ventricles, filled with cerebral spinal fluid, pushing the brain out against the skull. And for the neurologists out there… no fixed gait, no incontinence – in fact he is “compulsive” about working out.
The 3-D surface SPECT images
[from another SPECT center - not Amen Clinics] showed some typical findings: prefrontal cooling with a history of ADD, temporal lobe cooling with not understanding communications well, and anger out-of-the-blue. His previous SPECT report pronounced him free of Alzheimer’s and no frontal-temporal dementia – but this is the beginning of the rest of the story.
The tomography told a different story for this atypical “healthy guy,” with memory problems and a history of ADD.
Take a look at this relatively optimistic commentary:
The Neurology Channel gives this additional overview:
“Normal pressure hydrocephalus (NPH) is a condition that involves the build-up of fluid in the brain. Normally, a fluid called cerebrospinal fluid (CSF) circulates around the brain and spinal cord. This fluid cushions, cleanses, and brings nutrients to the cells in the brain and spine. CSF is produced in small, hollow spaces within the brain called ventricles. For people in good health, excess CSF normally drains away into the bloodstream as fresh CSF is produced.
When cerebrospinal fluid does not drain properly, the cerebrospinal fluid builds up in the ventricles and NPH can occur. This build up puts pressure on the brain, interfering with healthy brain function. NPH most commonly affects the areas of the brain that control leg movement, bladder function, and cognitive abilities such as problem solving, speaking, and remembering.
‘Hydrocephalus‘ was once called ‘water on the brain,’ but we now know that the water is CSF. The term ‘normal pressure’ refers to the fact that this type of hydrocephalus, which generally develops slowly, has a lower CSF-pressure than other types of hydrocephalus. Normal pressure hydrocephalus occurs mainly in people over the age of 60 and symptoms may be mistaken for other disorders, such as Parkinson’s disease, Alzheimer’s disease, dementia, or Creutzfeldt-Jakob disease. However, with proper diagnosis and treatment many of the symptoms of NPH can be controlled or greatly reduced. In some cases, a nearly complete recovery is possible.”
Shunt technology, to run the CSF back into the blood stream, has improved and this condition can likely be significantly corrected. This SPECT case proved the truth of the axiom: we do need to look at the brain to see what’s going on, and in this case, inside the brain-
cp
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- New System Developed for Early Diagnosis of Alzheimer’s Disease – Phramalive.com (pharmalive.com)
- Marcia G. Yerman: If It’s Not Alzheimer’s Disease or Parkinson’s Disease, It May Be NPH (huffingtonpost.com)
- If It’s Not Alzheimer’s Disease or Parkinson’s Disease, It May Be NPH (avantrasara.com)
- What is Hydrocephalus? (brighthub.com)
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Gina, This was a shocker for both of us [especially with the initial emotional lift from the first Nuc. Med finding of "no Alzheimer's"], and a difficult realization for him. Yes, it was hard for me as well - to tell him, as he is so dedicated to exercise and trying so hard - and so aware of the dementia decline with no apparent other symptoms. He is still on my thoughts... and, yes this meeting lived many layers of technology beyond psychoanalysis. - but those past years of my psychoanalytic training, those very long-term and detailed relationships, persuaded me me that a guy like this can deal with just about anything if he knows I am truly on the team with him and pull no punches. This scan view was a rare glimpse of a challenging presentation, and I felt it was essential to tell our CorePsychBlog readers about it - perhaps someone out there will look at a similar set of symptoms differently and consider SPECT evidence. And interesting in the context of the dementia and apparent ADD, You would have found the meeting most interesting, cp
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