When Age Isn’t the Problem

Thanks to a physician near her Vermont home who was enough uncertain of the diagnosis to refer her to a specialist, D’Ari ended up at Johns Hopkins, where a neurologist suspected not senility, but adult hydrocephalus—what laymen may refer to as “water on the brain.” Caused by excess cerebrospinal fluid in the ventricles, the condition produces blockages in the brain that interfere with the body’s normal ability to reabsorb cerebrospinal fluid, causing the brain to swell with the liquid.

“It can be triggered by any number of problems: infection, trauma, venous disturbances, brain tumor treatment,” explains neurological surgeon Paul Wang. “But because the symptoms mimic other problems of old age, there often can be little incentive for a doctor to probe deeper.” A CT scan showing enlarged ventricles and brain atrophy, for example, could indicate Alzheimer’s or Parkinson’s disease, but might also be signs of hydrocephalus. “It’s really a diagnosis of exclusion,” Wang says.

In D’Ari’s case, neurologists here performed a lumbar puncture, drained the fluid from her brain and watched what happened. Within hours, D’Ari was walking and thinking as she hadn’t for months. The evidence was in: She was a candidate for shunt surgery.

“Adult hydrocephalus can’t be cured,” Wang makes clear, “but we have several shunt techniques that can be wonderfully successful in suppressing the condition.” The method he cites with the lowest complication rate involves inserting a catheter with a one-way, programmable valve to move the fluid from the brain into the abdomen, where it’s reabsorbed. If this approach is inadvisable, a shunt can be inserted from the jugular vein in the neck to move fluid toward the heart. These methods aren’t surefire, Wang emphasizes, but a one-in-five failure rate drops to 6 percent or less after the first year.

What’s so rewarding about shunt surgery is its ability to lift a fog of confusion and frailty, allowing a sharper, more sure-footed human being to emerge. For D’Ari, it literally rolled back the clock. She became lucid and mobile, and for the first time in years, doctors evaluated her as normal.