{"id":296812,"date":"2026-02-14T00:00:09","date_gmt":"2026-02-14T00:00:09","guid":{"rendered":"https:\/\/www.newsbeep.com\/ie\/296812\/"},"modified":"2026-02-14T00:00:09","modified_gmt":"2026-02-14T00:00:09","slug":"miracles-do-happen-rare-case-of-normal-pressure-hydrocephalus-successfully-treated","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ie\/296812\/","title":{"rendered":"\u2018Miracles do happen!\u2019 Rare case of normal pressure hydrocephalus successfully treated"},"content":{"rendered":"

By\u00a0Jonathan Fincher<\/a><\/p>\n

At age 66, Richard \u201cDick\u201d Nash first suspected something might be wrong when he participated in a Dallas walk for juvenile diabetes in honor of his granddaughter. \u201cIt was only two miles \u2013 no big deal \u2013 but I wasn\u2019t able to complete it without falling down,\u201d he recalled. \u201cMy wife had to help me back to the car.\u201d<\/p>\n

After that day in 2011, Dick\u2019s health continued to deteriorate. His legs would stiffen involuntarily, his sense of balance worsened, and walking became increasingly difficult, if not impossible. The speed of his physical movements became noticeably slower overall. Even trying to concentrate felt sluggish, making everyday communication a challenge.<\/p>\n

Eventually he sought out a neurologist and was diagnosed in 2016 with\u00a0Parkinson\u2019s disease<\/a>, a progressive, degenerative disorder with no clear cause and no cure. He began physical therapy and medication, hoping to regain some of his mobility and cognition.<\/p>\n

But something didn\u2019t feel right for Dick.<\/p>\n

Even though he had the hallmark signs of Parkinson\u2019s \u2013 stiffness, slow movement, poor balance, cognitive issues, incontinence \u2013 many of the treatments didn\u2019t seem to make a difference. \u201cThe symptoms were never consistent,\u201d he said.<\/p>\n

Determined to find answers, Dick set out on a quest to regain his health. Fortunately, he had spent more than 10 years as an insurance agent and was familiar with navigating Medicare and the complex medical system. For the next several years, he cycled through numerous physicians and specialists.<\/p>\n

Then his journey led him to UT Southwestern. There, doctors at the\u00a0Peter O’Donnell Jr. Brain Institute<\/a>\u00a0identified the true culprit:\u00a0normal pressure hydrocephalus (NPH)<\/a>, a rare condition caused by excess fluid accumulating in the brain.<\/p>\n

With a dedicated team of NPH experts behind him, Dick underwent the surgery he needed to turn his health around. Within months of receiving the correct diagnosis, he’s regained his physical independence, his ability to communicate more easily, and precious quality time with his family. What started as a grim outlook for the future has turned into a new beginning.<\/p>\n

What is normal pressure hydrocephalus?<\/p>\n

Typically seen in patients over age 60, NPH is characterized by an excess buildup of cerebrospinal fluid (CSF) in the brain. A healthy body constantly creates CSF, cycles it through the brain, and reabsorbs it. When these processes are interrupted, extra fluid accumulates, compressing the brain and impairing its ability to clean itself. This can lead to progressive difficulties with:<\/p>\n

Mobility, particularly stiffness when walkingCognition, marked by sluggish thinking, confusion, and\/or forgetfulnessUrinary incontinence<\/p>\n

Unlike typical hydrocephalus, where patients have a significant increase in pressure on the brain, patients with NPH show little or no pressure increases, making the condition harder to detect. Recent international studies suggest that NPH affects about 1.5% to 3% of patients aged 70\u201377, and more than 6% of those 80 and older, which is considerably higher than the estimated prevalence of Parkinson\u2019s disease. That means as many as 1 to 2 million people in the U.S. may be living with NPH. Unfortunately, only about 20%-40% are ever diagnosed and receive treatment.<\/p>\n

Types of normal pressure hydrocephalus<\/p>\n

NPH is typically divided into two categories:<\/p>\n

Idiopathic NPH, where the exact cause is unknown but is usually attributed to aging issues that disrupt how CSF is circulated in the bodySecondary NPH, where the CSF disruption can be traced to another medical condition such as:Head injury<\/a>Surgery complicationsSubarachnoid hemorrhage (bleeding in the area around the brain)Brain tumors<\/a>Brain infections (such as meningitis)Brain inflammation<\/p>\n

NPH received a rare boost in the public spotlight in May 2025, when famed musician Billy Joel revealed his own diagnosis and began treatment.<\/p>\n

Related reading:\u00a0NPH: A misunderstood form of dementia that can be reversed<\/a><\/p>\n

The search for effective treatment<\/p>\n

In the years after Dick\u2019s diagnosis of Parkinson\u2019s, his illness became harder to manage. His leg stiffness worsened until he was mostly homebound. He needed a wheelchair anytime he left the house. His cognitive deficits also made it difficult for him to hold conversations or use the phone or a computer.<\/p>\n

All this took a toll on his main caregiver, his wife of more than 55 years. \u201cHe had basically given up,\u201d Sharon Nash said. \u201cHe didn’t want to live. He didn’t want to do anything, so his muscles had atrophied. He just was not motivated to care for himself.\u201d<\/p>\n

Fortunately for Dick, a routine visit to a physical therapist at UT Southwestern to help with his incontinence spurred the breakthrough he needed.<\/p>\n

Like his previous health care practitioners, pelvic floor specialist\u00a0Michelle Bradley, PT, DPT, WCS<\/a>\u00a0initially didn\u2019t see any reason to doubt Dick\u2019s Parkinson\u2019s diagnosis. She began working with him to ease his symptoms. It wasn\u2019t until Dick arrived for a later appointment in a wheelchair that she suspected something else might be going on. \u201cHe told me he had a procedure a couple of days earlier that required valium. Since then, he\u2019d had great difficulty walking,\u201d she said. \u201cKnowing valium does not cause such a quick and long-lasting decline, I was concerned.\u201d<\/p>\n

The next time she saw Dick, his condition had worsened. Even for Parkinson\u2019s, such a rapid change in a short period of time was unusual and raised a major red flag. \u201cI was so concerned that I walked with him to the front and asked that Mr. Nash be scheduled with a neurology specialist as soon as possible,\u201d she said.<\/p>\n

For the first time in years, Dick felt someone truly saw what he was going through.<\/p>\n

The first steps to an NPH diagnosis<\/p>\n

Dick initially met with\u00a0Vibhash Sharma, M.D.<\/a>, Medical Director of the Interventional (Neuromodulation) Movement Disorders Clinic at UT Southwestern. After a thorough evaluation, Dr. Sharma ruled out Parkinson\u2019s.<\/p>\n

Even though Dick\u2019s legs would freeze up and cause him to fall, he had not developed other conditions consistent with the disease. His prescription for levodopa, a standard Parkinson\u2019s medication that boosts dopamine levels in the brain, appeared to have no effect on his symptoms. A past DaT scan (Dopamine Transporter Scan) similarly failed to show strong evidence of Parkinson\u2019s.<\/p>\n

Based on a new MRI scan and his own clinical exam, Dr. Sharma referred Dick to the NPH group at UT Southwestern.<\/p>\n

The right team for the right diagnosis<\/p>\n

In February 2024, Dick had his first appointment with UT Southwestern\u2019s dedicated NPH team. The interdisciplinary group includes\u00a0Padraig O\u2019Suilleabhain, M.D.<\/a>, a neurologist specializing in\u00a0movement disorders<\/a>, and\u00a0Jeffrey Schaffert, Ph.D.<\/a>, a clinical neuropsychologist specializing in dementia syndromes.<\/p>\n

While some neurologists encounter NPH through their clinical practice, UT Southwestern has taken a more focused approach by forming a dedicated interdisciplinary team to tackle potential NPH cases. By combining their expertise, the team members can identify subtle signs of NPH more easily in patients, streamline care, and hopefully bring clarity to a notoriously ambiguous condition.<\/p>\n

Given Dick\u2019s symptoms and past testing, the team was not particularly surprised that Dick had received a Parkinson\u2019s diagnosis. As they set to work unraveling his extensive medical history and performing their own evaluations, however, they noted even more evidence of NPH.<\/p>\n

Clinical symptoms<\/p>\n

They studied his movements. \u201cHis walking difficulty had what we call \u2018magnetic gait,\u2019 where the tendency is for his feet to kind of stick to the ground as though there were magnets in his shoes,\u201d Dr. O\u2019Suilleabhain explained. \u201cIt\u2019s a classic gait complaint, and it had deteriorated over the course of 10 years or so.\u201d<\/p>\n

His negative DaT scan and the fact that he hadn\u2019t responded to levodopa concerned Dr. Schaffert. \u201cIf a patient gets a lot better [on levodopa], that would be more suggestive of Parkinson\u2019s in many cases,\u201d he said. \u201cThe fact that he didn’t get better raises a yellow flag of \u2018what else could we be dealing with?\u2019\u201d<\/p>\n

Dick\u2019s fluctuating symptoms also added to the potential evidence for a new diagnosis. \u201cIt’s certainly common for people to feel their brain operating differently at times, both physically in terms of how they walk and cognitively in how clearly they’re thinking,\u201d Dr. O’Suilleabhain said. \u201cSleep, caffeine, blood pressure, and even the weather can have an effect. Parkinson\u2019s symptoms can change in severity as neurons are lost, but the variation in CSF outflow that NPH causes produces a similar effect.\u201d<\/p>\n

Imaging<\/p>\n

Based on his scans, the ventricles in the middle of Dick\u2019s brain had enlarged a significant amount, likely caused by excess CSF and reduced outflow, which can disrupt communication between the brain and legs.<\/p>\n

There also was evidence of disproportionately enlarged grooves in the brain, which happens when CSF is trapped in those spaces. On scans, this can look like brain shrinkage, which may have contributed to Dick\u2019s earlier misdiagnosis.<\/p>\n

CSF drains<\/p>\n

One key detail the team noted was that Dick had already completed two lumbar spinal taps over the course of his illness. During these procedures, a small needle or catheter is inserted into the lower back to remove fluid around the spinal cord. Draining a large amount of CSF can sometimes relieve symptoms and aid in the diagnosis, although a lack of response does not rule out NPH. But for Dick, the results were inconclusive.<\/p>\n

The NPH diagnosis gap<\/p>\n

Unfortunately for patients with NPH, initial misdiagnosis is common.<\/p>\n

Unlike cognitive conditions that can be identified by certain markers, NPH lacks a definitive test (for example, brain scans of Alzheimer\u2019s patients typically show a buildup of a protein called amyloid, which forms structures that disrupt normal brain functions). Multiple health issues can further muddy the waters. Patients typically undergo CSF testing, lumbar drains, medication, and potentially surgery before their physicians reach a definitive diagnosis of NPH.<\/p>\n

The medical community seems to be catching on that NPH could be more prevalent than previously thought. Researchers in Sweden studying brain MRI scans from nearly 800 70-year-old patients found\u00a01.5% with evidence of NPH<\/a>\u00a0(an earlier study also revealed a\u00a0significantly higher prevalence among those over age 80<\/a>).<\/p>\n

This is one of the main reasons specialists at UT Southwestern have combined their expertise. \u201cWe’re trying to be more systematic about how we make an NPH determination,\u201d Dr. O’Suilleabhain said. While lumbar drains continue to be a factor in diagnosis, the team hopes to move away from such invasive testing to a more streamlined array of cognitive and mobility tests.<\/p>\n

The team also hopes to improve methods for distinguishing NPH from other conditions and predict treatment response by analyzing proteins in CSF and blood. As principal investigator, Dr. Schaffert helped move the research program forward significantly by securing $1.2 million in funding: \u201cWe were able to leverage our clinical pathway into substantial research efforts. We look forward to launching more advanced imaging, biomarker collection, and longitudinal follow-up for our patients this year.\u201d<\/p>\n

One last test to confirm NPH<\/p>\n

To help determine next steps, the NPH team proposed Dick undergo one more CSF drain along with a lumbar infusion test, a much more extensive diagnostic procedure not offered by many clinics.<\/p>\n

Dick was admitted to\u00a0William P. Clements Jr. University Hospital<\/a>, where a lumbar drain was placed on him for four days straight. Every four hours, doctors would drain 20 milliliters of CSF, essentially removing half of what his body produced and forcing the brain\u2019s fluid systems to reset. Dick reported some improvement, but like his previous drain tests, the results weren\u2019t definitive.<\/p>\n

During the same hospital visit, however, doctors also performed a lumbar infusion test, which uses real-time sensors to monitor intracranial pressure (ICP) and actively measure how well CSF flows and is absorbed by the brain. Dick\u2019s ICP became elevated during infusion and took a significant amount of time to lower.<\/p>\n

That result, along with imaging and clinical symptoms, provided enough evidence to diagnose Dick with NPH and support the recommendation of installing a shunt. There were no guarantees the shunt would help \u2013 and it would require surgery and possibly maintenance or replacement surgery down the road \u2013\u00a0but it was still the best chance for Dick to get back on his feet.<\/p>\n

After discussing the procedure with neurosurgeon\u00a0Jon White, M.D.<\/a>, a date was set.<\/p>\n

Relieving the brain pressure<\/p>\n

On Aug. 1, 2024, Dick arrived at the\u00a0Clements University Hospital<\/a>\u00a0for surgery.<\/p>\n

In Dick\u2019s eyes, this was his last shot to regain the life he\u2019d had before his illness. \u201cI decided if this surgery didn\u2019t work, I was going to declare hospice,\u201d he said. After years of setbacks and uncertainty, he was ready to move forward or let go.<\/p>\n

That day, Dick had two surgical teams \u2013 one to install a ventriculoperitoneal shunt into his skull and another to connect it to a drain in his abdomen. The shunt was inserted into the brain\u2019s ventricles, where the fluid appeared to accumulate the most. For the second part of the procedure, a long, thin tube was connected to the shunt and threaded through his neck and chest to the peritoneal cavity, a space in the abdomen that houses digestive organs.<\/p>\n

Once the procedures were completed, the shunt would act as a relief valve, opening to release CSF when the pressure in his ventricles got too high. The CSF would then flow down the tube into his abdomen to be absorbed by the body. Once the pressure returned to a normal range, the shunt would close again, stopping the flow of CSF. This way, the fluid pressure would stabilize, and the brain\u2019s waste removal system would be restored.<\/p>\n

Though shunts have been shown to improve functionality in NPH patients, their overall effects on cognition and mobility are still unclear. UT Southwestern recently participated in a\u00a0randomized controlled clinical trial<\/a>\u00a0involving multiple sites in the U.S., Canada, and Sweden to test the effectiveness of shunting \u2013 the first trial of its kind in the world. By understanding its full effects, doctors hope to determine which patients are likely to benefit.<\/p>\n

From NPH to rebirth<\/p>\n

Most patients with NPH don\u2019t see a significant difference for weeks or even months after a shunt is installed. For Dick, the change was almost immediate.<\/p>\n

Just one day after surgery, he did something he hadn\u2019t done in years: He got out of bed and counted as he took 250 steps with a walker. \u201cIt was the furthest I\u2019d walked in six months,\u201d Dick said. \u201cI\u2019d shown up for the surgery in a transport wheelchair, so walking that much was a big deal.\u201d This was, quite literally, his biggest step forward in years.<\/p>\n

Describing the surgery as his \u201cday of rebirth,\u201d Dick has been determined to stay healthy. More than one year later, he walks about three miles daily and has regained much of the functionality he thought he\u2019d lost forever. At 80, he\u2019s able to do more than he could almost 10 years ago. \u201cI can operate in the kitchen now,\u201d he said. \u201cI can go out when people invite me to leave the house. Sharon and I go out when we want to see a movie.\u201d The pair are even planning to travel internationally later this year.<\/p>\n

As part of his recovery, Dick began speech therapy, which helped him regain the socializing he\u2019d lost during his illness. According to Sharon, \u201cOne of the things that happens when you have an illness like he had is you become isolated. And the more isolated you become, the more cognitive deficits you develop. He\u2019s just so much better. Now he\u2019s able to converse with people and do a lot of things that he just wasn’t able to do before his surgery and before the therapy.\u201d<\/p>\n

Other symptoms have faded, too, including the incontinence that inadvertently put him on the path to healing. \u201cI don’t wear what we call \u2018traveling pants\u2019 anymore,\u201d Dick said. \u201cI also reduced my medication by about 60% \u2013 got rid of a lot of pills I don’t need anymore.\u201d<\/p>\n

Of everything he\u2019s gained over the past year, though, the most meaningful has been moments with his family. He\u2019s most proud of spending more quality time with his young great-grandsons and is grateful for those who helped him get there. \u201cDr. Schaffert, Dr. White, and Dr. O’Suilleabhain are heroes because they did what was necessary,\u201d Dick said. \u201cThey listened to me.\u201d<\/p>\n

After his own experience, Dick said his main hope is that NPH will gain more recognition in the medical community, so others can get the treatment they need to regain their lives.<\/p>\n

\u201cMiracles do happen,\u201d he said. \u201cAnd I was the beneficiary of a miracle.\u201d<\/p>\n

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