Hydrocephalus Diagnosis and Lumbar Surgery Concerns

Diagnosis of hydrocephalus and issues related to lumbar abdominal surgery?

Hello, Doctor.
My mother has been experiencing frequent falls over the past two years, with two incidents where she hit the back of her head.
For the past six months, she has felt weakness in her legs, and since last month, she has been walking unsteadily and has had episodes of feeling like she is going to fall forward.
Recently, we also noticed that she has a strong urge to urinate as soon as she feels the need.
Additionally, she has been experiencing memory issues and difficulty with logical thinking and speech.
Initially, we consulted a neurologist who ordered a CT scan and MRI, and the doctor at Hospital A diagnosed her with a cerebral infarction and prescribed medication, but there has been no improvement.
Later, we visited a doctor at Hospital B who suggested it might be hydrocephalus and recommended a lumbar puncture for drainage testing.
We are confused about how two doctors could have such different diagnoses.
However, considering the clinical presentation and the imaging showing enlarged ventricles resembling a butterfly, I tend to agree with the hydrocephalus diagnosis.
I would like to know your opinion on this matter.
Additionally, if a lumbar-peritoneal shunt surgery is performed, how large would the two incisions be? Will stitches be required, and will they need to be removed later? Thank you, and take care.

Liu Xiaojie, 40~49 year old female. Ask Date: 2022/09/01

Dr. Zhang Junwei reply Neurosurgery

A lumbar drainage test can confirm whether the symptoms are caused by hydrocephalus.

Reply Date: 2022/09/01

More Info

Hydrocephalus, often referred to as "water on the brain," is a condition characterized by an accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. This can lead to increased intracranial pressure, which may cause a variety of neurological symptoms. Your mother’s symptoms, including frequent falls, leg weakness, urinary urgency, and cognitive difficulties, are concerning and may indeed suggest hydrocephalus, especially in the context of her recent falls and the imaging findings you mentioned.

The discrepancy between the diagnoses from the two different hospitals can be attributed to the complexity of neurological conditions. While one physician may focus on the immediate effects of a stroke (cerebral infarction), another may recognize the potential for hydrocephalus, particularly if there are signs of ventricular enlargement on imaging studies like CT or MRI. The "butterfly-like" appearance of the ventricles you mentioned could indicate a significant alteration in CSF dynamics, which is consistent with hydrocephalus.

In terms of diagnosis, the lumbar puncture (or lumbar tap) is a common procedure used to assess CSF dynamics. It can help determine if there is an obstruction in the flow of CSF or if the pressure is elevated. The results from this procedure can provide critical information to guide treatment decisions. If hydrocephalus is confirmed, the standard treatment is the placement of a shunt, which helps to drain excess fluid and relieve pressure on the brain.

Regarding your concerns about lumbar surgery, specifically the placement of a lumbar-peritoneal shunt, the size of the incisions can vary based on the specific technique used and the surgeon's preference. Generally, the incisions for this type of procedure are relatively small, often around 2-3 centimeters in length. The procedure typically involves two incisions: one at the lumbar region to access the spinal canal and another in the abdominal area where the catheter will be placed.
As for sutures, it depends on the surgical technique used. Many modern techniques utilize absorbable sutures, which do not require removal. However, if non-absorbable sutures are used, they will need to be removed after a certain period, usually within a week or two post-surgery. Your surgeon will provide specific instructions regarding post-operative care, including wound care and signs of complications to watch for.

In conclusion, it is essential to follow up with a neurologist or neurosurgeon who specializes in hydrocephalus for further evaluation and management. They can provide a comprehensive assessment of your mother’s condition and discuss the potential benefits and risks of surgery. It is also advisable to keep an open line of communication with her healthcare providers to ensure that all concerns are addressed and that she receives the most appropriate care based on her unique situation.

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