Ask general practitioner Maarten: Hydrocephalus, excessive fluid in the cavities of the brain

Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand.

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Dear Martin,

About me:

– male, 62 years old
– BMI 22,8
– smoking no
– drink 1 bottle of beer/day
– exercise: 3/week 4,5 km/time

In July 2020 I had collapsed in my coffee shop after a 10 km bike ride, in the sense that I couldn't think and walk properly, elastic legs. Thought blood sugar too low and ate sugary peanuts and drank coke. After 20 minutes I drove home at a lower pace and an examination in the same private hospital resulted in a clean bill of health for my heart and lungs.
The brain was not part of the studies conducted at the time in July.

Because of "heavy eyes" and a headache that was like a band around my head, and that wouldn't go away after taking paracetamol, I went to a private hospital in Chiang Rai in November 2020 after seeing this for 4 weeks. I had also noticed an imbalance at times.

I ended up with the ENT specialist and he found my imbalance reason to admit me and to have an inner ear examination taken through the CT scanner. Because an enlarged cerebral fluid was seen on the scan (in the shape of a butterfly), the ENT doctor and the neurologist thought that an MRI should also be made and an appointment was made for 26/12/2020, one month later then the recording.

The result of the MRI was that the amount of cerebral fluid was present in the same shape and amount as on the CT scan a month earlier and that no tumor was found. The cause of the hydrocephalus, according to the specialists, is my age. Treatment consists of placing an internal drain, which is only placed if the complaints worsen, such as difficulty walking (shuffling), memory loss and incontinence.

Since the CT scan I have fewer complaints about heavy eyes and (band) headaches because I take it easier. Go back for a check up in 6 months. Went home with 10 Utraphen pills against the headache.

Questions I have for you are:

• is a drain only possible if I have worse complaints? I don't want to have a hole drilled in my head as a demented farang... Is there perhaps an intermediate solution in the form of medicines?
• no spinal cord puncture was done to measure pressure either. It didn't become clear in the discussion I had with the neurologist. Is that too early to do at this stage?
• my BP has gone up a bit. From previous values ​​(almost constant) 132/74 to 148/96 during his home recording in December 2020. What could be a cause of this?
• my wife and I notice that my fuse has become very short which manifests itself in overreacting to small things discussing it
  hardly worth. Could medication (which?) offer a solution?

Due to the observed changes in my personality, we are going to see the neurologist again next week.

Thank you in advance for your answer.

Regards,

H.

*****

Dear h,

It is always possible to install a drain, but as long as the pressure does not become too high, it is not always necessary. In your case, further exploration seems necessary and it is therefore good that you go to the neurologist again.

It often appears that there is more fluid present, because the brain atrophies (shrinks) with age. As a result, the ratio of fluid to brain tissue changes.

Personality changes can have many causes, including hydrocephalus. However, the fear of the future can also change the personality. Early dementia must be ruled out. That would of course be extremely annoying.

BP is often higher in the hospital due to stress. The home measurements give a much better picture, provided the measuring device works properly. The pressure in the brain can be measured invasively and non-invasively with an ultrasound. The non-invasive method is less accurate. Here's an article about the pressure measurement: www.umcutrecht.nl/nl/ziekenhuis/treatment/hersendruk-meten

Medication will come down to antipsychotics and that doesn't seem like the first choice to me. Utraphen is a combination of tramadol (a highly addictive opiate) and paracetamol. Doesn't seem like the ideal medication to me.

Here's another review article: www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Adult-Onset-Hydrocephalus?formid=124

It seems to me that you are on the right track. A psychological test will probably also be done.

Good luck and let's hope for the best.

Yours faithfully,

Dr. Maarten