Grey Matter

by Robin Wilson, M.D., Ph.D.
Sandra and Malcolm Berman Brain & Spine Institute

Last night, we once again got to see Grey's Anatomy's Dr. Izzie Stevens at Seattle Grace Hospital (Season 6, episode 9, “New History”), pushing the wheelchair of her high school teacher, Dr. Singer (played by Joel Grey). Izzie returned not to reclaim her career, but to demand a medical workup to determine why her mentor went from teaching school to living in a nursing home in less than one year. After a lumbar puncture, Dr. Singer leapt from the exam table, his confusion cleared and his ability to walk restored. Izzie realized that Dr. Singer had a treatable disease - normal pressure hydrocephalus (NPH) - and set out to talk her friends into providing free shunt surgery for him.

Every week at the Adult Hydrocephalus Center of the Sandra and Malcolm Berman Brain & Spine Institute, we evaluate patients for possible NPH. Like Dr. Singer, most of our patients are older than 60 and have experienced a gradual decline in balance and ability to walk; some are wheelchair bound. Many also have mild dementia and loss of bladder control. We diagnose NPH by reviewing the patient’s medical history, signs and symptoms, physical exam, brain MRI, and response to removal of cerebrospinal fluid by lumbar puncture or extended drainage (while in the hospital). Because the symptoms associated with NPH have many other causes, we evaluate patients thoroughly to confirm that surgery is likely to help before we recommend it.

Though sometimes remarkable improvement is achieved with shunt surgery, the magnificent and instantaneous response demonstrated by Dr. Singer is not what we expect to see. Typically after shunt surgery, our patients experience gradual improvement over 6–9 months. As the shunt only treats hydrocephalus, if a patient has other disorders contributing to dementia, mobility impairment, or loss of bladder control, unfortunately, he or she will have only partial improvement with the shunt. We tell our patients, “We can make you better, but we can’t make you any younger.”

Izzie had the right idea, though - no Grey area about it. A patient who has a progressive course of gait or cognitive impairment deserves a complete medical workup to screen for a treatable disorder such as NPH.

To learn more about normal pressure hydrocephalus, visit the Adult Hydrocephalus Center or call 410-601-WELL.