Podcasts about Hydrocephalus

Join Jay Gunkelman, QEEGD (the man who has analyzed over 500,000 brain scans), Dr. Mari Swingle (author of i-Minds), and host Pete Jansons for another engaging NeuroNoodle Neurofeedback Podcast episode discussing neuroscience, psychology, mental health, and brain training.✅ Topic 1 Explained: Billy Joel's Health & Normal Pressure Hydrocephalus — Jay explains how ventricles and cerebrospinal fluid can affect cognition, mobility, and speech, and when a shunt can be life-changing.✅ Topic 2 Deep Dive: Ozzy Osbourne, Parkinson's & Peak Performer Brains — The panel explores how legendary performers sustain their creativity, the toll it takes on the brain, and whether neurofeedback can help.✅ Topic 3 Insights: Chemo Brain Fog & Neurofeedback Solutions — Jay and Mari share how neurofeedback, hyperbaric oxygen, and photobiomodulation can help ease cognitive fog after chemotherapy.✅ Additional Topics:

Childhood-onset hydrocephalus encompasses a wide range of disorders with varying clinical implications. There are numerous causes of symptomatic hydrocephalus in neonates, infants, and children, and each predicts the typical clinical course across the lifespan. Etiology and age of onset impact the lifelong management of individuals living with childhood-onset hydrocephalus. In this episode, Casey Albin, MD, speaks with Shenandoah Robinson, MD, FAANS, FAAP, FACS, author of the article “Childhood-onset Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Robinson is a professor of neurosurgery, neurology, and pediatrics at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Childhood-onset Hydrocephalus Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Albin: Hi, this is Dr Casey Albin. Today I'm interviewing Dr Shenandoah Robinson about her article on childhood onset hydrocephalus, which appears in the June 2025 Continuum issue on disorders of CSF dynamics. Dr Robinson, thank you so much for being here. Welcome to the podcast. I'd love to start by just having you briefly introduce yourself to our audience. Dr Robinson: I'm a pediatric neurosurgeon at Johns Hopkins, and I'm very fortunate to care for kids and children from the neonatal intensive care unit all the way up through young adulthood. And I have a strong interest in developing better treatments for hydrocephalus. Dr Albin: Absolutely. And this was a great article because I really do think that understanding how children with hydrocephalus are treated really does inform how we can care for them throughout the continuum of their lifespan. You know, I was shocked in reading your article about the scope of the problem for childhood onset hydrocephalus. Can you walk our listeners through what are the most common reasons why CSF diversion is needed in the pediatric population? Dr Robinson: For the United States, and Canada too, the most common reasons are spina bifida---so, a baby that's born with a myelomeningocele and then develops associated hydrocephalus---and then about equally as common is posthemorrhagic hydrocephalus of prematurity, congenital causes such as from aquaductal stenosis, and other genetic causes are less common. And then we also have kids that develop hydrocephalus after trauma or meningitis or tumors or other sort of acquired problems during childhood. Dr Albin: So, it's a really diverse and sort of heterogeneous causes that across sort of the, you know, the neonatal period all the way to, you know, young adulthood. And I'm sure that those etiologies really shift based on sort of the subgroup population that you're talking about. Dr Robinson: Yes, they definitely shift over time. Fortunately for our kids that are born with problems that raise concerns, such as myelomeningocele or if they're born preterm, they sort of declare themselves by the time they're a year old. So, if you're an adult provider, they should have defined themselves and it's unlikely that they will suddenly develop hydrocephalus as a teenager or older adult. Dr Albin: Totally makes sense. I think many of the listeners to this podcast are adult neurologists who are probably very familiar with external ventriculostomies for temporary CSF diversion, and with the more permanent ventricular peritoneal shines or ventricular atrial or plural shines that are needed when there's the need for permanent diversion. But you described in your article two procedures that provide temporary CSF diversion that I think many of our listeners are probably not as familiar with, which is the ventricular access devices and ventriculosubgaleal shunts. Can you briefly describe what those procedures provide? Who are the candidates for them? And then what complications neurologists may need to think about if they're consulted for comanagement in one of these complex patients? Dr Robinson: Well, the good thing is that if as an adult neurologist you encounter someone with, you know, residual tubing from one of these procedures, you are unlikely to need to do anything about it. So, we put in ventricular access device or ventriculosubgaleal shunts, usually in newborns or infants. And sometimes when they no longer need the device, we just leave it in because that saves them an extra surgery. So, if you encounter one later on, it's most likely you won't need to do anything. Often if the baby goes on to show that they need a permanent shunt, we go ahead and put in that permanent shunt. We may or may not go back and take out the reservoir or the subgaleal shunt. The reservoir and subgaleal shunts are often put in the frontal location. Sometimes we'll put the permanent shunt in the occipital location and just leave the residual tubing there. So, you're very unlikely to need to intervene with a reservoir or subgaleal shunt if you encounter an older child or adult with that left in. We use these in the small babies because the external ventricular drains that we're very familiar with have a very high complication rate in this population. In the adult ICU, you often see these, and maybe there's, you know, a few percent risk of infection. It actually heads into 20 to 25% in our preterm infants and other newborns that require one of these devices for drainage. So, we try not to use external ventricular drains like we use in older patients. We use the internalized device: either the ventricular reservoir with a little area for us to tap every day, every other day; or the ventriculosubgaleal shunt, which diverts the spinal fluid to a pocket in the scalp. So, we use these in preterm infants that are too tiny for a permanent shunt. And for some of our babies that are born, for example, with an omphalocele, that we can't use their peritoneal cavity and so we need some temporizing device to manage their CSF. Dr Albin: Totally makes sense. And so just to clarify, I mean, this is a tube that's placed into the ventricles of the brain and then it's tunneled into the subgaleal space and the collection, the CSF, just builds up there, like? Dr Robinson: Yeah. Dr Albin: And over time either, you know, the baby will learn how to account for that extra CSF, and then I guess it's just reabsorbed? Dr Robinson: Yeah. When it's present, though, it looks like maybe, I don't know if you're familiar with like a tissue expander. There is this bubble of fluid under the scalp, but it's prominent, it can be several centimeters in diameter. Dr Albin: Wow, that's just absolutely fascinating. And I don't think I've ever had the opportunity to see this in clinical practice. I've really learned quite a bit about this. I assume that these children are going to go on to get some sort of permanent diversion. And then, you know, over time, those permanent shunts do create a lot of problems. And so, I was hoping you could kind of walk us through, you know, what are some of the things that you're seeing that you're concerned about? And then if you've just inherited a patient who had a shunt placed at, say, a different institution, how do you go about figuring out what kind of shunt it is and if they're still dependent on it? Dr Robinson: There's a few things that, fortunately, technology is helping with. So, it is much easier now for patients to get their images uploaded to image-sharing software, and then we can download their images into our institutional software, which is very helpful. Another option is that we are strongly encouraging our families to use a app such as HydroAssist that's available from the Hydrocephalus Association. So that's an app that goes on your phone, and you can upload the images from an MRI or a CT scan or x-rays from a shunt series. And then that you can take if you're traveling and you have to go to emergency department or you're establishing care with a new provider, you can have your information right there and not be under stress to remember it. It also has areas so you can record the type of valve. And all of our valves have pluses and minuses, they all tend to malfunction a little bit. And they can be particularly helpful with different types of hydrocephalus. I really doubt that we're going to narrow down from the fifteen or so valves we have access to now. And so, recording your valve type, the manufacturer as well as the setting, is very helpful when you're transferring care or if you're traveling and then have to, unfortunately, stop in the emergency department. Dr Albin: Yeah, I thought that was a really great pearl that, like, families now are empowered to sort of take control of understanding sort of the devices that they have, the settings that they're using. And what an incredible thing for providers who are going to care for these patients who, you know, unfortunately do end up in centers that are not their primary center. The other challenge that I find… I practice as a neurointensivist, and sometimes patients come in and they have a history of being shunt dependent and they present with a neurologic change. And I think that we as neurologists can be a little quick to blame the shunt and want the shunt to be tapped. And I was really struck in reading this article about the complexity of shunt taps. And I was hoping, you know, can you kind of walk us through what's involved and maybe why we should have a little bit of a higher threshold before just saying, ah, just have the neurosurgeons tap the shunt. Like, it's not that straightforward. Dr Robinson: And it may depend on the population you're caring for. So, when I was at a different institution, we actually published that there's about a 5% complication rate from shunt taps. And that may be- that was in pediatric patients. And again, that may be population dependent, but you can introduce infection to a perfectly clean shunt by doing a shunt tap. You can also cause an acute shunt malfunction. So that's why we tend to prefer that only neurosurgeons are doing shunt taps for evaluation of a shunt malfunction. There are times that, for example, our patients who are getting intrathecal chemotherapy or something have a CSF access device like an Ommaya reservoir, and other providers may tap that reservoir to instill medicine. But that's different than an evaluation, like, you're talking about somebody with a neurological change. And so, it is possible that if somebody has small ventricles or something, if you tap that shunt, you can take a marginally functioning shunt and turn it into an acute proximal malfunction, which is an emergency. Dr Albin: Absolutely. I think that's a fantastic pearl for us to take away from this. It's just that heightened level. And kind of on the flip side of that, you know, and I really- I do feel for us when we're trying to kind of, you know, make a case that it's, it's not the shunt. Many of our shunted patients also have a lot of neurologic complexity, which I think you really talked upon in this article. I mean, these are patients who have developmental cognitive delays and that they have epilepsy and that they're at risk for, you know, complications from prematurity, since that's a very common reason that patients are getting shunts. But from your experience as a neurosurgeon, what are some of the features that make you particularly concerned about shnut malfunction? And how do you sort of evaluate these patients when they come in with that altered mental status? Dr Robinson: It is challenging, especially for our patients that have, you know, some intellectual delay or other difficulties that make it hard for them to give an accurate history. Problem is, if they're sick and lethargic, they may not remember the symptoms that they had when they were sick. But sometimes there's hopefully there's a family member present that does remember and can say, oh, no, this is what they look like when they have a viral illness. And this is different from when they have the shot malfunction, which was projectile emesis, not associated with a fever. It's rare to have a fever with a shunt malfunction, although shunt infection often presents with malfunction. So, it's not completely exclusionary. We often look at the imaging, but it's taking the whole picture together. Some of the common other diagnoses we see are severe constipation that can decrease the drainage from the shunt and even cause papilledema in some people. So, we look at that as well on the shunt series. It's very important to have the shunt series if you're concerned about shunt malfunction or- the shunt tubing is good. It tends to last maybe 20to 25 years before it starts to degrade. And so, you may have had a functioning shunt for decades and it worked well and you're very dependent on it, and then it breaks and you become ill. But on the flip side, we have patients that have had a broken shunt for years, they just didn't know about it. And we don't want to jump in and operate on them and then cause complexities. And so, it is a challenge to sort out. The simplest thing is obviously if they come in and their ventricles are significantly larger, and that goes along with a several-hour or a couple-day deterioration, that's a little more clear-cut. Dr Albin: Absolutely. And you talked about this shunt series. What other imaging- and, sort of maybe walk us through, what's involved in a shunt series, what are you looking at? And then what other imaging is sort of your preferred method for evaluating these patients? Dr Robinson: In adult patients, the shunt series is the x-ray from the entire shunt. And so, if they have an atrial shunt, that would be skull x-ray plus a chest x-ray; or the shunt ends in the perineal cavity, it goes to the perineum. And we're looking for continuity. We're looking for the- sometimes as people grow and age, the ventricular catheter can pull out of the ventricle. So, we're looking to make sure that the ventricular catheter is in an optimal position relative to the skull. We can also look at the valve setting to see the type of valve. So, that can also be helpful as well. And then in terms of additional imaging, a CT scan or an MRI is helpful. If you don't know what type of valve they have, they should not, ideally, go in the MRI scanner. We like to know what their setting is before they go in the MRI because we're going to have to reset the valve after they come out of the MRI if it's a programmable valve. Dr Albin: This is fantastic. I've heard several pearls. So, one is that with the shunt series, which, am I correct in understanding those are just plain X-rays? Dr Robinson: Yes. Dr Albin: Right. Then we can look for constipation, and that might be actually something really serious in a pediatric patient that could clue us in that they could actually be developing hydrocephalus or increased ICP just because of the abdominal pressure. And then that we need to be mindful of what are the stunt settings before we expose anyone to the MRI machine. Is that two good takeaways from all of this? Dr Robinson: Yes. And it's very rare that there'll be an MRI tech that will allow a patient with a valve in the MRI without knowing what it is. So, they have their job security that way. But yeah, if you're not sure, just go ahead and get the CT. Obviously, in our younger kids, we're trying to avoid CT scans. But if you're weighing off trying to decide if somebody has a shunt malfunction versus, you know, waiting 12 or 24 hours for an MRI, go ahead and get the CT. Dr Albin: Absolutely. I love it. Those are things I'm going to take with me for this. I have one more question about these shunts. So, every now and then, and I think you started to touch on this, we will get a shunt series and we'll see that the catheter is fractured. Do the patients develop little- like, a tract that continues to allow diversion even though the catheter is fractured? Dr Robinson: Yes. So, they can develop scar tissue around, and some people have more scar tissue than others. You'll even see that sometimes, say, the catheter has fractured and we'll take out that old fractured tubing and put in new tubing on the other side. But if you go and palpate their neck or chest, you'll still feel that tract is there because it calcifies along the tract. Some patients drain through that calcified tract for weeks or months without symptoms, and then it can occlude off. So, we don't consider it a reliable pathway. It's also not a reliable pathway if you're positioned prone in the OR. So some of our orthopedic colleagues, for example, if they go to do a spine fusion, we like to confirm that the shunt is working before you undergo that long anesthesia, but also that you're going to be positioned prone and you could potentially- you know, the pressure could occlude that track that normally is open. Dr Albin: This is fantastic. I feel like I've gotten everything I've ever wanted to know about shunts and all of their complications in this, which is, you know, this is really difficult. And I think that because we are not trained to put these in, sometimes we see them and we just say, oh, it's fractured that must be a malfunction. But it's good to know that sometimes those patients can drain through, you know, a sort of scarred-down tract, but that it may not be nearly as reliable as when they have the tubing in place. Another really good thing that I'm going to put in my back pocket for the next time I see a patient with a potential shunt malfunction. Dr Robinson: And we do have some patients that the tubing is fractured years ago and they don't need it repaired, and that totally can be challenging when they then transfer to your practice for follow-up care. We tend to follow those patients very closely, both our clinic visits as well as having them seen by ophthalmology. So, there are teenagers and young adults out there that have… their own system has recovered and they are no longer shunt-dependent; and they may have a broken shunt and not actually be using that track, but they usually have had fairly intensive follow up to prove that they're not shunt-dependent. And we still have a healthy respect there that, you know, if they start to get a headache, we're going to take that quite seriously as opposed to, you know, some of our shunt patients, about 10 to 20%, have chronic headaches that are not shunt-related. So, not everybody who has a headache and has a shunt has a shunt malfunction. It's tough. Dr Albin: This is really tough. That actually brings me to sort of the last clinical scenario that I was hoping we could get your perspective on. And I think this would be of great interest to neurologists, especially in the context that these children may develop headaches that have nothing to do with the shunt. I'd like to sort of give you this hypothetical case that I'm a neurologist seeing a patient in clinic and it's a teenager, maybe a young adult, and they had a shunt placed early in childhood. They've done really well. And they've come to me for management of a new headache. And, you know, as part of this workup, their primary care provider had ordered an MRI. And, you know, I look at the MRI, and I don't think that the ventricles look really enlarged. They don't look overdrained. Is having an MRI that looks pretty okay, is that enough to exonerate the shunt in this situation? Dr Robinson: In most cases it is. The one time that we don't see a substantial change in the ventricles is if we have a pseudocyst in the abdomen. The ventricles cannot enlarge initially, and then later on they might enlarge. So, we see that sometimes that somebody will come in and their ventricles will be stable in size, but we're still a little bit suspicious. They've got this persistent headache. They may have, you know, some emesis or loss of appetite, loss of activity, and a slower presentation than you would get with an acute proximal malfunction. We can check an abdominal ultrasound for them. And sometimes, even though the ventricles haven't changed in size, they still have a malfunction because they have that distal pseudocyst. One of the questions that we ask our patients when we're establishing care, in addition to what valve type they have and what sort of their shunt history or other interventions such as endoscopic third ventriculostomy, is to ask if their ventricles enlarge when they have a shunt malfunction. There is a small fraction where they do not. They kind of have a stiff brain, if you will. And so, it's good to know that. That's one of the key factors is asking somebody, do the ventricles enlarge when they have a malfunction? If they have enlarged in the past, they're likely to enlarge again if they have a malfunction. But again, it's not 100%. So, in peds, 20% of the time the ventricles don't enlarge. So, in adults, I'm not that- you know, I don't know what percentage it is, but it's something to consider that you can have a stable ventricular size and still have a shunt malfunction. So, if your clinical judgment, you're just kind of, like, still uneasy, you know, respect that and maybe do a little more workup. That's why we so much want patients to establish care with somebody, whether it's a neurologist or a neurosurgeon or other provider in some areas that have fewer neurospecialists, but to establish care so that you all know what a change is for that patient. That's really important. Dr Albin: That's fantastic. So, to summarize that, it's really important to understand the patient's baseline and how they presented with prior shunt complications, if they've had some. That if they're coming in with a new headache that we don't have a baseline, so, we should just have a heightened level of awareness that, like, the shunt has a start and it has an end. And even if the start of the shunt in the brain looks okay, there still could be the potential for complications in the abdomen. And maybe the third thing I heard from that is that we should look for GI symptoms and sort of be aware of when there could be a complication in the abdomen as well. Does that all sound about right? Dr Robinson: And especially for our kids with spina bifida and for posthemorrhagic hydrocephalus are now adults, because the preterm infants are prone to necrotizing enterocolitis. And they may not have had surgery for it, but they still may have adhesions and other things that predispose them to develop pseudocysts over time. And then our individuals with spina bifida often have various abdominal surgeries and other procedures to help them manage their bowel and bladder function. And so that can also create adhesions that then predisposes to pseudocysts. So, we do have a healthy respect for that. In addition, it used to be---because we have gotten a little better with shunts over time---it used to be, like, when I was in training that you heard, you know, if you haven't had a shunt malfunction for 10 or 15 years, you must- you may no longer be dependent. And that's not really true. There are some people who outgrow their need for shunt dependence, but not everyone does outgrow it. And so, you can be 15, 20 years without a shunt revision and still be shunt-dependent. Dr Albin: Those are fantastic pearls. I think most of them, walking away with this, like, a very healthy respect for the fact that these are complex patients, which the shunt is one component of sort of the things that can go wrong and that we have to have a really healthy respect and really detailed investigation and sort of take the big picture. I really like that. Dr Robinson: Yeah, I know. I think it's- there's a very strong push amongst pediatric neurosurgery and a lot of the related, our colleagues in other areas, to develop multidisciplinary transition clinics and lifespan programs for these patients to help keep everything else optimized so that they're not coming in, for example, with seizures. But then you have to figure out if this is a seizure or a shunt; you know, if we can keep them on track, if we can keep them healthy in all their other dimensions, it makes it safer for them in terms of their shunt malfunction. Dr Albin: Absolutely. I love that, and just the multidisciplinary preventative aspect of trying to keep these patients well. So important. Dr Robinson, I really would like to thank you for your time. We're getting towards the end of our time together. Are there any other points about the article that you just are anxious that leave the readers with, or should I just direct them back to the fantastic review that you've put together on this topic? Dr Robinson: No, I think that we covered a lot of the high points. I think one of the really exciting things for hydrocephalus is that there's a lot of investigations into other options besides shunts for certain populations. We are seeing less hydrocephalus now with the fetal repair of the myelomeningocele, which is great. And we're trying to make inroads into posthemorrhagic hydrocephalus as well. So, there are a lot of great things on the horizon and, you know, hopefully someday we won't have the need to have these discussions so much for shunts. Dr Albin: I love it. I think that's really important. And all of those points were touched on the article. And so, I really invite our listeners to go and check out the article, where you can see sort of, like, how this is evolving in real time. Thank you, Dr Robinson. Please go and check out the childhood-onset hydrocephalus article, which appears in the most recent issue of Continuum on the disorders of CSF dynamics. And be sure to check out Continuum Audio episodes from this and other issues. Thank you again to our listeners for joining us today. And thank you, Dr Robinson. Dr Robinson: Thanks for having me. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Normal pressure hydrocephalus (NPH) is a pathologic condition whereby excess CSF is retained in and around the brain despite normal intracranial pressure. MRI-safe programmable shunt valves allow for fluid drainage adjustment based on patients' symptoms and radiographic images. Approximately 75% of patients with NPH improve after shunt surgery regardless of shunt type or location. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Kaisorn L. Chaichana, MD, author of the article “Management of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology at the University of California San Francisco in the Department of Neurology in San Francisco, California. Dr. Chaichana is a professor of neurology in the department of neurological surgery at the Mayo Clinic in Jacksonville, Florida. Additional Resources Read the article: Management of Normal Pressure Hydrocephalus Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @kchaichanamd Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. The article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr Chaichana: Yeah, thank you for having me. I'm Kaisorn Chaichana. I'm a neurosurgeon at Mayo Clinic in Jacksonville, Florida. Part of my practice is doing hydrocephalus care, which includes shunts for patients with normal pressure hydrocephalus. Dr Berkowitz: Fantastic. Well, before we get into shunt considerations and NPH specifically, which I know is the focus of your article, I thought it would be a great opportunity for a neurologist to pick a neurosurgeon's brain a bit about shunts. So, to start, can you lay out for us the different types of shunts and shunt procedures, the advantages, disadvantages of each type of shunt, how you think about which shunt procedure should be used for which patient, that type of thing? Dr Chaichana: Yeah. So, there are different types of shunts, and the most common one that is used is called a ventricular peritoneal shunt. So, it has a ventricular catheter, it has a catheter that tunnels underneath the skin and it goes into the peritoneum where the fluid goes from the ventricular system into the peritoneum. Typically, the shunts are in the ventricle because that is the largest fluid-filled space in the brain. Other terminal areas include the atrium, which is really the jugular vein, and those are called ventricular atrial shunts. You can also have ventricular pleural shunts, which end in the pleural space and drain flui into the pleural space. Those are pretty much the most common ventricular shunts. There's also a lumboperitoneal shunt that drains from the lumbar spine, similar to a lumbar drain into the peritoneum. For the lumbar shunts, we don't typically have a lumbar pleural or lumbar atrial shunt just because of the pressure dynamics, because the lumbar spine is below the lung and as well as the atrium. And so, the drainage pattern is very different than ventricular peritoneal which is top to bottom. The most common shunt, why we use the ventricular peritoneal shunt the most, is because it has the most control. So, the peritoneum is set at a standard pressure in the intraabdominal pressure, whereas the ventricular atrial shunt depends on your venous return or venous pressure and your ventricular pleural shunt varies with inspiration and expiration. So, the easiest way for us to control the fluid, the ventricular system is through the ventricular peritoneal shunt. And that's why that's our most common shunt that we use. Dr Berkowitz: Fantastic. So, as you mention in the article, neurologists may be reluctant to offer a shunt to patients with NPH because many patients may not improve, or they improve only transiently; and out of fear of shunt complications. So, of course, as neurologists, we often only hear about a patient's shunt when there is a problem. So, we have this sort of biased view of seeing a lot of shunt malfunction and shunt infection. Of course, we might not see the patient if their shunt is working just fine. How common are these complications in practice, and how do you as a neurosurgeon weigh the risks against the often uncertain or transient benefits of a shunt in a patient with NPH who may be older and multiple medical comorbidities? How do you think about that and talk about it with patients? Dr Chaichana: When you hear about shunt complications, most of the shunt complications you hear about are typically in patients with congenital hydrocephalus. Those patients often require several shunt revisions just from either growing or the shunt stays in for a long time or the ventricular caliber is a lot less than some with normal pressure hydrocephalus. So, we don't really see a lot of complications with normal pressure hydrocephalus. So that shunt placement in these patients is typically pretty safe. The procedure's a relatively short procedure, around 30 minutes to 45 minutes to place a shunt, and we can control the pressure within the shunt setting so that we don't overdrain---which means too much fluid drains from the ventricular system---which can cause things like a subdural, which is probably the most common complication associated with normal pressure hydrocephalus. So, to obviate those risks, what we do is typically insert the shunt and then keep the shunt setting at a high setting. The higher the setting, the less it drains, and then we bring it slowly down based on the patient's symptoms to try to minimize the risk of this over drainage in the subdural hematoma while at the same time benefiting the patient. So, there's a concern for shunt in patients with normal pressure hydrocephalus. The concern or the complication risks are very low. The problem with normal pressure hydrocephalus, though, is that over time these patients benefit less and less from drainage or their disease process takes over. So, I do recommend placing this shunt as soon as possible just so that we can maximize their quality of life for that period of time. Dr Berkowitz: So, if I'm understanding you, then the risk of complication is more sort of due to the mechanical factors in patients with congenital hydrocephalus or sort of outgrowing the shunt, their pressure dynamics may be changing over time. And in your experience, an older patient with NPH, although they may have more medical comorbidities, the procedure itself is relatively quick and low-risk. And the actual complications due to mechanical factors, my understanding, are just much less common because the patient is obviously fully grown and they're getting one sort of procedure at one point in time and tend to need less revision, have less complication. Is that right? Dr Chaichana: Yeah, that's correct. The complication risk for normal hydrocephalus is a lot less than other types of hydrocephalus. Dr Berkowitz: That's helpful to know. While we're talking about some of these complications, let's say we're following a patient in neurology with NPH who has a shunt. What are some of the symptoms and signs of shunt malfunction or shunt infection? And what are the best studies to order to evaluate for these if we're concerned about them? Dr Chaichana: Yeah. So basically, for shunt malfunction, it's basically broken down into two categories. It's either overdrainage or underdrainage. So, underdrainage is where the shunt doesn't function enough. And so basically, they return to their state before the shunt was placed. So that could be worsening gait function, memory function, urinary incontinence are the typical symptoms we look for in patients with normal pressure hydrocephalus and underdrainage, or the shunt is not working. For patients that are having overdrainage, which is draining too much, the classic sign is typically headaches when they stand up. And the reason behind that is when there's overdrainage, there's less cerebrospinal fluid in their ventricular system, which means less intracranial pressure. So that when they stand up, the pressure differential between their head and the ground is more than when they're lying down. And because of that pressure differential, they usually have worsening headaches when standing up or sitting up. The other thing are severe headaches, which would be a sign of a subdural hematoma or focality in their neurological symptoms that could point to a subdural hematoma, such as weakness, numbness, speaking problems, depending on the hemisphere. How we work this up is, regardless if you're concerned about overdrainage or underdrainage, we usually start with a CAT scan or an MRI scan. Typically, we prefer a CAT scan because it's quicker, but the CAT scan will show us if the ventricular caliber is the same and/or the placement of the proximal catheter. So, what we look for when we see that CAT scan or that MRI to see the location of the proximal catheter to make sure it hasn't changed from any previous settings. And then we see the caliber of the ventricles. If the caliber of the ventricles is smaller, that could be a sign of overdrainage. If the caliber of the ventricles are larger, it could be a sign of underdrainage. The other thing we look for are subdural fluid collections or hydromas or subdural hematomas, which would be another sign of lower endocranial pressure, which would be a sign of overdrainage. So those are the biggest signs we look for, for underdrainage and overdrainage. Other things we can look for if we're concerned of the shunt is fractured, we do a shunt X-ray and what a shunt x-ray is is x-rays of the skull, the neck and the abdomen to see the catheter to make sure it's not kinked or fractured. If you're really concerned, you can't tell from the x-ray, another scan to order is a CT of the chest and abdomen and pelvis to look at the location of the catheter to make sure there's no brakes in the catheter, there's no fluid collections on the distal portion of the catheter, which would be a sign of shunt malfunction as well. Other tests that you can do to really exclude shunt malfunction is a shunt patency test, and what that is a nuclear medicine test where radionucleotide is injected into the valve and then the radionucleotide is traced over time or imaged through time to make sure that it's draining appropriately from the valve into the distal catheter into the peritoneum or the distal site. If there's a shunt malfunction that's not drainage, that radioisotope would remain stagnant either in the valve or in the catheter. There's overdrainage, we can't really tell, but there will be a quick drainage of the radioisotope. For shunt infection, we start with an imaging just to make sure there's not a shunt malfunction, and that usually requires cerebrospinal fluid to test. The cerebrospinal fluid can come from the valve itself, or it can come from other areas like the lumbar spine. If the lumbar spine is showing signs of shunt infection, then that usually means the shunt is infected. If the valve is aspirated with- at the bedside with a butterfly needle into the valve and that shows signs of shunt infection, that also could be a sign of infection. Dr Berkowitz: That's very helpful. You mentioned CT and shunt series. One question that often comes up when obtaining neuroimaging in patients with a shunt, who have NPH or otherwise, is whether we need to call you when we're doing an MRI to reprogram the shunt before or after. Is there a way we can know as a neurologists at the bedside or as patients carry a card, like with some devices where we know whether we have to call and bother our neurosurgery colleagues to get this MRI? Or if the radiology techs ask us, is this safe? And is the patient's shunt going to get turned off? How do we go about determining this? Dr Chaichana: Yeah, so unfortunately, a lot of patients don't carry a card. We typically offer a card when we do the shunt, but that card, there's two problems with it. One is it tells the model, but the second thing is it has to be updated any time the shunt is changed to a different setting. Oftentimes patients don't know that shunt setting, and often times they don't know that company brand that they use. There are different types of shunts with different types of settings. If there's ever concern as to what type of shunt they have, an x-ray is usually the best bet to see with a shunt series, or a skull x-ray. A lateral skull x-ray usually looks at the valve, and the valve has certain radio-dense markers that indicate what type of shunt it is. And that way you can call neurosurgery and we can always tell you what the shunt setting is before the MRI is done. Problem with an MRI scan if you do it without a shunt x-ray before is that you don't know the setting before unless the patient really knows or it's in the patient chart, and the MRI can need to change the setting. It doesn't usually turn it off, but it would change the setting, which would change the fluid dynamics within their ventricular system, which could lead to overdrainage or underdrainage. So, any time a patient needs MRI imaging, whether it's even the brain MRI, a spine MRI, or even abdominal MRI, really a shunt x-ray should be done just to see the shunt setting so that it could be returned to that setting after the MRI is done. Dr Berkowitz: So, the only way to know sort of what type of shunt it would be short of the patient knowing or the patient getting care at the same hospital where the shunt was placed and looking it up in the operative reports would be a skull film. That would then tell us what type of shunt is there and then the marking of the setting. And then we would be able to call our colleagues in neurosurgery and say, this patient is getting an MRI this is the setting, this is the type of shunt. And do we need to call you afterwards to come by and reprogram it? Is that right? Dr Chaichana: That's correct, yeah. Dr Berkowitz: Is there anything we would be able to see on there, or it's best we just- best we just call you and clarify? Dr Chaichana: The easiest thing to do is, when you get the skull x-ray, you can Google different types of shunts or search for different shunts, and they'll have markers that show the type of shunt it is as well as the setting that it's at. And just match it up with the picture. Dr Berkowitz: And as long as it's not a programmable shunt, there's no concern about doing the MRI. Is that right? Dr Chaichana: Correct. So, if it's a programmable shunt, even if it's MRI-compatible, we still like to get the setting before and make sure the setting after the MRI is the same. Nonprogrammable shunts can't be changed with MRI scans, and those don't need neurosurgery after the MRI scan, but it should be confirmed before the scan is done. Dr Berkowitz: Very helpful. Okay, so let's turn to NPH specifically. As you know, there's a lot of debate in the literature, some arguing, even, NPH might not even exist, some saying it's underdiagnosed. I think. I don't know if it was last year at our American Academy of Neurology conference or certainly in recent years, there was a pro and con debate of “we are underdiagnosing NPH” versus “we are overdiagnosing NPH.” What's your perspective as a neurosurgeon? What's the perspective in neurosurgery? Is this something we're underdiagnosing, and the times you shunt these patients you see miraculous results? Is this something that we're overdiagnosing, you get a lot of patients sent to that you think maybe won't benefit from a shunt? Or is it just really hard to say and some patients have shunt-responsive noncommunicating hydrocephalus of unclear etiology and either concurrent Parkinson's disease, Alzheimer's, cervical lumbar stenosis, neuropathy, vestibular problems, and all these other issues that play into multifactorial gait to sort of display a certain amount of the percentage of problem in a given patient or take overtime? What's your perspective if you're open to sharing it, or what's the perspective of neurosurgery? Is this debated as it is in neurology or this is just a standard thing you see and patients respond to shunt to some degree in some proportion of the time? And what are the sort of predictors you see in your experience? Dr Chaichana: Yeah, so, for me, I'd say it's too complicated for a neurosurgeon to evaluate. We rely on neurology to tell us whether or not they need a shunt. But I think the problem is, obviously, a part of the workout for at least the ones that I like to do, is that I want them to have a high-volume lumbar puncture with pre- and postgait analysis to see if there's really an objective measure of them improving. If they have an objective measure of improvement---and what's even better is that they have a subjective measure of improvement on top of the objective measure of improvement---then they benefit from a shunt. The problem is, some patients do benefit even though they don't have objective performance increases after a high-volume shunt. And those are the ones that make me the most worrisome to do the shunt, just because I don't like to do a procedure where there's no benefit for the patient. I do see, according to the literature as well, that there's around a 30 to 40%, even 50%, increase in gait function, even in patients that don't have large improvements following the high-volume lumbar puncture. And those are the most challenging patients for us as neurosurgeons because we'll put the shunt in, they say we're no better in terms of their gait, no better in terms of their urinary incontinence. We try to lower their shunt down to a certain setting and we're kind of stuck after that point. The good thing about NPH, though, is that, from the neurosurgery side, the shunt, like I said, is a pretty benign, low-risk procedure. So, we're not putting the patient through a very severe procedure to see if there's any benefit. So, in cases where we try to improve their quality of life in patients that don't have a benefit from high-volume lumbar puncture, we give them the odds of whether or not it's improving and say it might not improve. But because the procedure's minimally invasive, I think it's a good way to see if we can benefit their quality of life. Dr Berkowitz: Yeah, it's a very helpful perspective. Yeah, those are the most challenging cases on our side as well, right. If the patient- we think they may have NPH, or their gait and/or urinary and/or cognitive problems are- at least have a component of NPH that could be reversible, we certainly want to do the large volume lumbar puncture and/or consider a lumbar drain trial, all discussed in other articles and interviews for this issue of Continuum, But the really tough ones, as you said, there is this literature on patients who don't respond to the large-volume lumbar puncture for some reason but still may be shunt responsive. And despite all the imaging predictors and all the other ways we try to think about this, it's hard to know who's going to benefit. I think that's really a helpful perspective from your end that, as you say in the very beginning of your article, right, maybe there's a little bit too much fear of shunting on the neurology side because when we hear about shunts, it's often in the setting of complication. And so, we're not sort of getting the full spectrum of all the patients you shunt and you see who are doing just fine. They might not improve---the question is related to NPH---but at least they're not harmed by the shunt, and we're maybe overbiased and/or seeing a overly representative sample of negative shunt outcomes when they're actually not that common in practice. Is that a fair summary of your perspective? Dr Chaichana: Yeah, that's correct. So, I mean, complications can occur---and anytime you do a surgery, there are risks of complications---but I think they're relatively low for the benefit that we can help their quality of life. And the procedure's pretty short. So, the risk, it mostly outweighs the benefits in cases with normal pressure hydrocephalus. Dr Berkowitz: Very helpful perspective. So, well, thanks so much again. Today I've been interviewing Dr Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Billy Joel recently had to cancel the rest of his tour following a recent diagnosis of Normal Pressure Hydrocephalus (NPH). So what is NPH? Listen to learn. https://bit.ly/3Isn21nIn this Episode:01:42 - Billy Joel's Illness Announcement03:54 - Road Trip to Georgia: Ghosts and Coca-Cola Cake08:28 - What is Normal Pressure Hydrocephalus (NPH)?11:19 - The Trifecta of NPH symptoms13:35 - How NPH is Diagnosed14:18 - How NPH is Treated20:43 - Hope is Quieter than Fear - by John RoedelWith dizziness, confusion, and incontinence of urine as the typical symptoms, Normal Pressure Hydrocephalus (NPH) is a condition that could easily be mistaken for the ravages of old age, yet it is treatable. Getting a prompt diagnosis helps improve chances of a good outcome. Learn all about it in this episode.Support the showGet show notes and resources at our website: every1dies.org. Facebook | Instagram | YouTube | mail@every1dies.org

 Normal pressure hydrocephalus (NPH) is a clinical syndrome of gait abnormality, cognitive impairment, and urinary incontinence. Evaluation of CSF dynamics, patterns of fludeoxyglucose (FDG) uptake, and patterns of brain stiffness may aid in the evaluation of challenging cases that lack typical clinical and structural radiographic features. In this episode, Katie Grouse, MD, FAAN, speaks with Aaron Switzer, MD, MSc, author of the article “Radiographic Evaluation of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Switzer is a clinical assistant professor of neurology in the department of clinical neurosciences at the University of Calgary in Calgary, Alberta, Canada. Additional Resources Read the article: Radiographic Evaluation of Normal Pressure Hydrocephalus Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr. Switzer: Thanks so much for having me, Katie. I'm a neurologist that's working up in Calgary, Alberta, Canada, and I have a special interest in normal pressure hydrocephalus. So, I'm very happy to be here today to talk about the radiographic evaluation of NPH. Dr Grouse: I'm so excited to have you here today. It was really wonderful to read your article. I learned a lot on a topic that is not something that I frequently evaluate in my clinic. So, it's really just a pleasure to have you here to talk about this topic. So, I'd love to start by asking, what is the key message that you hope for neurologists who read your article to take away from it? Dr. Switzer: The diagnosis of NPH can be very difficult, just given the clinical heterogeneity in terms of how people present and what their images look like. And so, I'd like readers to know that detailed review of the patient's imaging can be very helpful to identify those that will clinically improve with shunt surgery. Dr Grouse: There's another really great article in this edition of Continuum that does a really great job delving into the clinical history and exam findings of NPH. So, I don't want to get into that topic necessarily today. However, I'd love to hear how you approach a case of a hypothetical patient, say, where you're suspicious of NPH based on the history and exam. I'd love to talk over how you approach the imaging findings when you obtain an MRI of the brain, as well as any follow-up imaging or testing that you generally recommend. Dr. Switzer: So, I break my approach down into three parts. First, I want to try to identify ventriculomegaly and any signs that would support that, and specifically those that are found in NPH. Secondly, I want to look for any alternative pathology or evidence of alternative pathology to explain the patient's symptoms. And then also evaluate any contraindications for shunt surgery. For the first one, usually I start with measuring Evans index to make sure that it's elevated, but then I want to measure one of the other four measurements that are described in the article, such as posterior colossal angle zed-Evans index---or z-Evans index for the American listeners---to see if there's any other features that can support normal pressure hydrocephalus. It's very important to identify whether there are features of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, which can help identify patients who may respond to shunt surgery. And then if it's really a cloudy clinical picture, it's complicated, it's difficult to know, I would usually go through the full evaluation of the iNPH radscale to calculate a score in order to determine the likelihood that this patient has NPH. So, the second part of my evaluation is to rule out evidence of any alternative pathology to suggest another cause for the patient's symptoms, such as neurodegeneration or cerebrovascular disease. And then the third part of my evaluation is to look for any potential contraindications for shunt surgery, the main one being cerebral microbleed count, as a very high count has been associated with the hemorrhagic complications following shunt surgery. Dr Grouse: You mentioned about your use of the various scales to calculate for NPH, and your article does a great job laying them out and where they can be helpful. Are there any of these scales that can be reasonably relied on to predict the presence of NPH and responsiveness to shunt placement? Dr. Switzer: I think the first thing to acknowledge is that predicting shunt response is still a big problem that is not fully solved in NPH. So, there is not one single imaging feature, or even combination of imaging features, that can reliably predict shunt response. But in my view and in my practice, it's identifying DESH, I think, is really important---so, the disproportionately enlarged subarachnoid space hydrocephalus---as well as measuring the posterior colossal angle. I find those two features to be the most specific. Dr Grouse: Now you mentioned the concept of the NPH subtypes, and while this may be something that many of our listeners are familiar with, I suspect that, like myself when I was reading this article, there are many who maybe have not been keeping up to date on these various subtypes. Could you briefly tell us more about these NPH subtypes? Dr. Switzer: Sure. The Japanese guidelines for NPH have subdivided NPH into three different main categories. So that would be idiopathic, delayed onset congenital, and secondary normal pressure hydrocephalus. And so, I think the first to talk about would be the secondary NPH. We're probably all more familiar with that. That's any sort of pathology that could lead to disruption in CSF dynamics. These are things like, you know, a slow-growing tumor that is obstructing CSF flow or a widespread meningeal process that's reducing absorption of CSF, for instance. So, identifying these can be important because it may offer an alternative treatment for what you're seeing in the patient. The second important one is delayed onset congenital. And when you see an image of one of these subtypes, it's going to be pretty different than the NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. Clinically, you may see that the patients have a higher head circumference. So, the second subtype to know about would be the delayed onset congenital normal pressure hydrocephalus. And when you see an image of one of these subtypes, it's going to be a little different than the imaging of NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. And there are two specific subtypes that I'd like you to know about. The first would be long-standing overt ventriculomegaly of adulthood, or LOVA. And the second would be panventriculomegaly with a wide foramen of magendie and large discernomagna, which is quite a mouthful, so we just call it PAVUM. The importance of identifying these subtypes is that they may be amenable to different types of treatment. For instance, LOVA can be associated with aqueductal stenosis. So, these patients can get better when you treat them with an endoscopic third ventriculostomy, and then you don't need to move ahead with a shunt surgery. And then finally with idiopathic, that's mainly what we're talking about in this article with all of the imaging features. I think the important part about this is that you can have the features of DESH, or you can not have the features of DESH. The way to really define that would be how the patient would respond to a large-volume tap or a lumbar drain in order to define whether they have this idiopathic NPH. Dr Grouse: That's really helpful. And for those of our listeners who are so inclined, there is a wonderful diagram that lays out all these subtypes that you can take a look at. I encourage you to familiarize yourself with these different subtypes. Now it was really interesting to read in your article about some of the older techniques that we used quite some time ago for diagnosing normal pressure hydrocephalus that thankfully we're no longer using, including isotope encephalography and radionuclide cisternography. It certainly made me grateful for how we've come in our diagnostic tools for NPH. What do you think the biggest breakthrough in diagnostic tools that are now clinically available are? Dr. Switzer: You know, definitely the advent of structural imaging was very important for the evaluation of NPH, and specifically the identification of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, in the late nineties has been very helpful for increasing the specificity of diagnosis in NPH. But some of the newer technologies that have become available would be phase-contrast MRI to measure the CSF flow rate through the aqueduct has been very helpful, as well as high spatial resolution T2 imaging to actually image the ventricular system and look for any evidence of expansion of the ventricles or obstruction of CSF flow. Dr Grouse: Regarding the scales that you had referenced earlier, do you think that we can look forward to more of these scales being automatically calculated and reported by various software techniques and radiographic interpretation techniques that are available or going to be available? Dr. Switzer: Definitely yes. And some of these techniques are already in development and used in research settings, and most of them are directed towards automatically detecting the features of DESH. So, that's the high convexity tight sulci, the focally enlarged sulci, and the enlarged Sylvian fissures. And separating the CSF from the brain tissue can help you determine where CSF flow is abnormal throughout the brain and give you a more accurate picture of CSF dynamics. And this, of course, is all automated. So, I do think that's something to keep an eye out for in the future. Dr Grouse: I wanted to ask a little more about the CSF flow dynamics, which I think may be new to a lot of our listeners, or certainly something that we've only more recently become familiar with. Can you tell us more about these advances and how we can apply this information to our evaluations for NPH? Dr. Switzer: So currently, only the two-dimensional phase contrast MRI technique is available on a clinical basis in most centers. This will measure the actual flow rate through the cerebral aqueduct. And so, in NPH, this can be elevated. So that can be a good supporting marker for NPH. In the future, we can look forward to other techniques that will actually look at three-dimensional or volume changes over time and this could give us a more accurate picture of aberrations and CSF dynamics. Dr Grouse: Well, definitely something to look forward to. And on the topic of other sort of more cutting-edge or, I think, less commonly-used technologies, you also mentioned some other imaging modalities, including diffusion imaging, intrathecal gadolinium imaging, nuclear medicine studies, MR elastography, for example. Are any of these modalities particularly promising for NPH evaluations, in your opinion? Do you think any of these will become more popularly used? Dr. Switzer: Yes, I think that diffusion tract imaging and MR elastography are probably the ones to keep your eye out for. They're a little more widely applicable because you just need an MR scanner to acquire the images. It's not invasive like the other techniques mentioned. So, I think it's going to be a lot easier to implement into clinical practice on a wide scale. So, those would be the ones that I would look out for in the future. Dr Grouse: Well, that's really exciting to hear about some of these techniques that are coming that may help us even more with our evaluation. Now on that note, I want to talk a little bit more about how we approach the evaluation and, in your opinion, some of the biggest pitfalls in the evaluation of NPH that you've found in your career. Dr. Switzer: I think there are three of note that I'd like to mention. The first would be overinterpreting the Evans index. So, just because an image shows that there's an elevated Evans index does not necessarily mean that NPH is present. So that's where looking for other corroborating evidence and looking for the clinical features is really important in the evaluation. Second would be misidentifying the focally enlarged sulci as atrophy because when you're looking at a brain with these blebs of CSF space in different parts of the brain, you may want to associate that to neurodegeneration, but that's not necessarily the case. And there are ways to distinguish between the two, and I think that's another common pitfall. And then third would be in regards to the CSF flow rate through the aqueduct. And so, an elevated CSF flow is suggestive of NPH, but the absence of that does not necessarily rule NPH out. So that's another one to be mindful of. Dr Grouse: That's really helpful. And then on the flip side, any tips or tricks or clinical pearls you can share with us that you found to be really helpful for the evaluation of NPH? Dr. Switzer: One thing that I found really helpful is to look for previous imaging, to look if there were features of NPH at that time, and if so, have they evolved over time; because we know that in idiopathic normal pressure hydrocephalus, especially in the dash phenotype, the ventricles can become larger and the effacement of the sulci at the convexity can become more striking over time. And this could be a helpful tool to identify how long that's been there and if it fits with the clinical history. So that's something that I find very helpful. Dr Grouse: Absolutely. When I read that point in your article, I thought that was really helpful and, in fact, I'm guessing something that a lot of us probably aren't doing. And yet many of our patients for one reason or other, probably have had imaging five, ten years prior to their time of evaluation that could be really helpful to look back at to see that evolution. Dr. Switzer: Yes, absolutely. Dr Grouse: It's been such a pleasure to read your article and talk with you about this today. Certainly a very important and helpful topic for, I'm sure, many of our listeners. Dr. Switzer: Thank you so much for having me. Dr Grouse: Again, today I've been interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Normal pressure hydrocephalus (NPH) is a clinical syndrome characterized by the triad of gait apraxia, cognitive impairment, and bladder dysfunction in the radiographic context of ventriculomegaly and normal intracranial pressure. Accurate diagnosis requires consideration of clinical and imaging signs, complemented by tests to exclude common mimics. In this episode, Lyell Jones, MD, FAAN speaks with Abhay R. Moghekar, MBBS, author of the article “Clinical Features and Diagnosis of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Moghekar is an associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Clinical Features and Diagnosis of Normal Pressure Hydrocephalus Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Abhay Moghekar, who recently authored an article on the clinical features and diagnosis of normal pressure hydrocephalus for our first-ever issue of Continuum dedicated to disorders of CSF dynamics. Dr Moghekar is an associate professor of neurology and the research director of the Cerebrospinal Fluid Center at Johns Hopkins University in Baltimore, Maryland. Dr Moghekar, welcome, and thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Moghekar: Thank you, Dr Jones. I'm Abhay Moghekar. I'm a neurologist at Hopkins, and I specialize in seeing patients with CSF disorders, of which normal pressure hydrocephalus happens to be the most common. Dr Jones: And let's get right to it. I think most of our listeners who are neurologists in practice have encountered normal pressure hydrocephalus, or NPH; and it's a challenging disorder for all the reasons that you outline in your really outstanding article. If you were going to think of one single most important message to our listeners about recognizing patients with NPH, what would that be? Dr Moghekar: I think I would say there are two important messages. One is that the triad is not sufficient to make the diagnosis, and the triad is not necessary to make the diagnosis. You know these three elements of the triad: cognitive problems, gait problems, bladder control problems are so common in the elderly that if you pick 10 people out in the community that have this triad, it's unlikely that even one of them has true NPH. On the other hand, you don't need all three elements of the triad to make the diagnosis because the order of symptoms matters. Often patients develop gait dysfunction first, then cognitive dysfunction, and then urinary incontinence. If you wait for all three elements of the triad to be present, it may be too late to offer them any clear benefit. And hence, you know, it's neither sufficient nor necessary to make the diagnosis. Dr Jones: That's a really great point. I think most of our listeners are familiar with the fact that, you know, we're taught these classic triads or pentads or whatever, and they're rarely all present. In a way, it's maybe a useful prompt, but it could be distracting or misleading, even in a way, in terms of recognizing the patient. So what clues do you use, Dr Moghekar, to really think that a patient may have NPH? Dr Moghekar: So, there are two important aspects about gait dysfunction. Say somebody comes in with all three elements of the triad. You want to know two things. Which came first? If gate impairment precedes cognitive impairment, it's still very likely that NPH is in the differential. And of the two, which are more- relatively more affected? So, if somebody has very severe dementia and they have a little bit of gait problems, NPH is not as likely. So, is gait affected earlier than cognitive dysfunction, and is it affected to a more severe degree than cognitive dysfunction? And those two things clue me in to the possibility of NPH. You still obviously need to get imaging to make sure that they have large ventricles. One of the problems with imaging is large ventricles are present in so many different patients. Normal aging causes large ventricles. Obviously, many neurodegenerative disorders because of cerebral atrophy will cause large ventricles. And there's an often-used metric called as the events index, which is the ratio of the bitemporal horns- of the frontal horns of the lateral ventricles compared to the maximum diameter of the skull at that level. And if that ratio is more than 0.3, it's often used as a de facto measure of ventriculomegaly. What we've increasingly realized is that this ratio changes with age. And there's an excellent study that used the ADNI database that looked at how this ratio changes by age and sex. So, in fact, we now know that an 85-year-old woman who has an events index of 0.37 which would be considered ventriculomegaly is actually normal for age and sex. So, we need to start adopting these more modern age- and sex-appropriate age cutoffs of ventriculomegaly so as not to overcall everybody with big ventricles as having possible NPH. Dr Jones: That's very helpful. And I do want to come back to this challenge that we've seen in our field of overdiagnosis and underdiagnosis. But I think most of us are familiar with the concept of how hydrocephalus could cause neurologic deficits. But what's the latest on the mechanism of NPH? Why do some patients get this and others don't? Dr Moghekar: Very good question. I don't think we know for sure. And it for a long time we thought it was a plumbing issue. Right? And that's why shunts work. People thought it was impaired CSF absorption, but multiple studies have shown that not to be true. It's likely a combination of impaired cerebral blood flow, biomechanical factors like compliance, and even congenital factors that play a role in the pathogenesis of NPH. And yes, while putting in shunts likely drains CSF, putting in a shunt also definitely changes the compliance of the brain and affects blood flow to the subcortical regions of the brain. So, there are likely multiple mechanisms by which shunts benefit, and hence it's very likely that there's no single explanation for the pathogenesis of NPH. Dr Jones: We explored this in a recent Continuum issue on dementia. Many patients who have cognitive impairment have co-pathologies, multiple different causes. I was interested to read in your article about the genetic risk profile for NPH. It's not something I'd ever really considered in a disorder that is predominantly seen in older patients. Tell us a little more about those genetic risks. Dr Moghekar: Yeah, everyone is aware of the role genetics plays in congenital hydrocephalus, but until recently we were not aware that certain genetic factors may also be relevant to adult-onset normal pressure hydrocephalus. We've suspected this for a long time because nearly half of our patients who come to us to see us in clinic with NPH have head circumferences that are more than 90th percentile for height. And you know, that clearly indicates that this started shortly at the time after birth or soon afterwards. So, we've suspected for a long time that genetic factors play a role, but for a long time there were not enough large studies or well-conducted studies. But recently studies out of Japan and the US have shown mutations in genes like CF43 and CWH43 are disproportionately increased in patients with NPH. So, we are discovering increasingly that there are genetic factors that underlie even adult onset in patients. There are many more waiting to be discovered. Dr Jones: Really fascinating. And obviously getting more insight into the risk and mechanisms would be helpful in identifying these patients potentially earlier. And another thing that I learned in your article that I thought was really interesting, and maybe you can tell us more about it, is the association between normal pressure hydrocephalus and the observation of cervical spinal stenosis, many of whom require decompression. What's behind that association, do you think? Dr Moghekar: That's a very interesting study that was actually done at your institution, at Mayo Clinic, that showed this association. You know, as we all get older, you know, the incidence of cervical stenosis due to osteoarthritis goes up, but the incidence of significant, clinically significant cervical stenosis in the NPH population was much higher than what we would have expected. Whether this is merely an association in a vulnerable population or is it actually causal is not known and will need further study. Dr Jones: It's interesting to speculate, does that stenosis affect the flow of CSF and somehow predispose to a- again, maybe a partial degree for some patients? Dr Moghekar: Yeah, which goes back to the possible hydrodynamic theory of normal pressure hydrocephalus; you know, if it's obstructing normal CSF flow, you know, are the hydrodynamics affected in the brain that in turn could lead to the development of hydrocephalus. Dr Jones: One of the things I really enjoyed about your article, Abhay, was the very strong clinical focus, right? We can't just take an isolated biomarker or radiographic feature and rely on that, right? We really do need to have clinical suspicion, clinical judgment. And I think most of our listeners who've been in practice are familiar with the use and the importance of the large-volume lumbar puncture to determine who may have, and by exclusion not have, NPH, and then who might respond to CSF diversion. And I think those of us who have been in this situation are also familiar with the scenario where you think someone may have NPH and you do a large-volume lumbar puncture and they feel better, but you can't objectively see a difference. How do you make that test useful and objective in your practice? What do you do? Dr Moghekar: Yeah, it's a huge challenge in getting this objective assessment done carefully because you have to remember, you know, subconsciously you're telling the patients, I think you have NPH. I'm going to do this spinal tap, and if you walk better afterwards, you're going to get a shunt and you're going to be cured. And you can imagine the huge placebo response that can elicit in our subjects. So, we always like to see, definitely, did the patient subjectively feel better? Because yes, that's an important metric to consider because we want them to feel better. But we also wanted to be grounded in objective truths. And for that, we need to do different tests of speed, balance and endurance. Not everyone has the resources to do this, but I think it's important to test different domains. Just like for cognition, you know, we just don't test memory, right? We test executive function, language, visuospatial function. Similarly, walking is not just walking, right? It's gait speed, it's balance, and it's endurance. So, you need to ideally test at least most of these different domains for gait and you need to have some kind of clear criteria as to how are you going to define improvement. You know, is a 5% improvement, is a 10% improvement in gait, enough? Is 20%? Where is that cutoff? And as a field, we've not done a great job of coming up with standardized criteria for this. And it varies currently, the practice varies quite significantly from center to center at the current time. Dr Jones: So, one of the nice things you had in your article was helpful tips to be objective if you're in a lower-resource setting. For you, this isn't a common scenario that someone encounters in their practice as opposed to a center that maybe does a large volume of these. What are some relatively straightforward objective measures that a neurologist or someone else might use to determine if someone is improving after a large-volume LP? Dr Moghekar: Yeah, excellent question, Dr Jones, and very practically relevant too. So, you need to at least assess two of the domains that are most affected. One is speed and one is balance. You know, these patients fall ultimately, right, if you don't treat them correctly. In terms of speed, there are two very simple tests that anybody can do within a couple of minutes. One is the timed “up-and-go” test. It's a test that's even recommended by the CDC. It correlates very well with faults and disability and it can be done in any clinic. You just need about ten feet of space and a chair and a stopwatch, and it takes about a minute or slightly more to do that test. And there are objective age-associated norms for the timed up-and-go test, so it's easy to know if your patient is normal or not. The same thing goes for the 10-meter walk test. You do need a slightly longer walkway, but it's a fairly easy and well-standardized test. So, you can do one of those two; you don't need to do both of them. And for balance, you can do the 30-second “sit-to-stand”; and it's literally, again, 30 seconds. You need a chair, and you need somebody to watch the patient and see how many times they can sit up and stand up from a seated position. Then again, good normative data for that. If you want to be a little more sophisticated, you can do the 4-stage balance test. So, I think these are tests that don't add too much time to your daily assessment and can be done with even trained medical assistants in any clinic. And you don't need a trained physical therapist to do these assessments. Dr Jones: Very practical. And again, something that is pretty easily deployed, something we do before and then after the LP. I did see you mentioned in your article the dual timed up-and-go test where it's a simultaneous gait and executive function test. And I've got to be honest with you, Dr Moghekar, I was a little worried if I would pass that test, but that may be beyond the scope of our time today. Actually, how do you do that? How do you do the simultaneous cognitive assessment? Dr Moghekar: So, we asked them to count back from 100, subtracting 3. And we do it particularly in patients who are mildly impaired right? So, if they're already walking really good, but then you give them a cognitive stressor, you know, that will slow them down. So, we reserve it for patients who are high-performing. Dr Jones: That's fantastic. I'm probably aging myself a little here. I have noticed in my career, a little bit of a pendulum swing in terms of the recognition or acceptance of the prevalence of normal pressure hydrocephalus. I recall when I was a resident, many, many people that we saw in clinic had normal pressure hydrocephalus. Then it seemed for a while that it really faded into the background and was much less discussed and much less recognized and diagnosed, and less treated. And now that pendulum seems to have swung back the other way. What's behind that from your perspective? Dr Moghekar: It's an interesting backstory to all of this. When the first article about NPH was published in the Newman Journal of Medicine, it was actually a combined article with both neurologists and neurosurgeons on it. They did describe it as a treatable dementia. And what that did is it opened up the floodgates so that everybody with any kind of dementia started getting shunts left, right, and center. And back then, shunts were not programmable. There were no antibiotic impregnated catheters. So, the incidence of subdural hematomas and shunt-related infections was very high. In fact, one of our esteemed neurologists back then, Houston Merritt, wrote a scathing editorial that Victor and Adam should lose their professorships for writing such an article because the outcomes of these patients were so bad. So, for a very long period of time, neurologists stopped seeing these patients and stopped believing in NPH as a separate entity. And it became the domain of neurosurgeons for over two or three decades, until more recently when randomized trials started being done early on out of Europe. And now there's a big NIH study going on in the US, and these studies showed, in fact, that NPH exists as a true, distinct entity. And finally, neurologists have started getting more interested in the science and understanding the pathophysiology and taking care of these patients compared to the past. Dr Jones: That's really helpful context. And I guess that maybe isn't rare when you have a disorder that doesn't have a simple, straightforward biomarker and is complex in terms of the tests you need to do to support the diagnosis, and the treatment itself is somewhat invasive. So, when you talk to your patients, Dr Moghekar, and you've established the diagnosis and have recommended them for CSF diversion, what do you tell them? And the reason I ask is that you mentioned before we started recording, you had a patient who had a shunt placed and responded well, but continued to respond over time. Tell us a little bit more about what our patients can expect if they do have CSF diversion? Dr Moghekar: When we do the spinal tap and they meet our criteria for improvement and they go on to have a shunt, we tell them that we expect gait improvement definitely, but cognitive improvement may not happen in everyone depending on what time, you know, they showed up for their assessment and intervention. But we definitely expect gait improvement. And we tell them that the minimum gait improvement we can expect is the same degree of improvement they had after their large-volume lumbar puncture, but it can be even more. And as the brain remodels, as the hydrodynamics adapt to these shunts… so, we have patients who continue to improve one year, two years, and even three years into the course of the intervention. So, we're, you know, hopeful. At the same time, we want to be realistic. This is the same population that's at risk for developing neurodegenerative disorders related to aging. So not a small fraction of our patients will also have Alzheimer's disease, for example, or go on to develop Lewy body dementia. And it's the role of the neurologist to pick up on these comorbid conditions. And that's why it's important for us to keep following these patients and not leave them just to the neurosurgeon to follow up. Dr Jones: And what a great note to end on, Dr Moghekar. And again, I want to thank you for joining us, and thank you for such a wonderful discussion and such a fantastic article on the clinical diagnosis of normal pressure hydrocephalus. I learned a lot reading the article, and I learned a lot more today just in the conversation with you. So, thank you for being with us. Dr Moghekar: Happy to do that, Dr Jones. It was a pleasure. Dr Jones: Again, we've been speaking with Dr Abhay Moghekar, author of a wonderful article on the clinical features and diagnosis of NPH in Continuum's first-ever issue dedicated to disorders of CSF dynamics. Please check it out. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In this powerful episode, we journey to the United Kingdom to hear from Grace Mbuthia, a devoted mother of three. Grace opens up about raising her eldest daughter, 13-year-old Lexi, who was diagnosed with autism at age 3—alongside other complex medical conditions including Selective Mutism, Hydrocephalus, and Epilepsy.Grace shares how the early years were filled with confusion, as Lexi didn't present with the typical signs of autism. With so many overlapping medical concerns, the autism diagnosis initially felt like another label being added. But over time, Lexi's ability to mask became clearer.Through humor, resilience, and unwavering love, Grace reflects on the past ten years of advocacy, growth, and learning. She also discusses her work in the care sector, supporting vulnerable adults and her growing efforts to serve children and families navigating similar challenges.This episode is a moving reminder that autism often doesn't come alone—and that no mom has to walk this path in isolation.Connect with Grace on Instagram: @_gra_cie_5Follow us on Instagram and Facebook: @theabmpodcastYouTube: theabmpodcastFollow on TikTok: @autismforbadassmomsInterested in being a guest on the show? Head over to our website and fill out the Guest Inquiry Form-we'd love to hear your story!

Dr. Mitch Shulman can be heard every weekday morning at 7:50 on The Andrew Carter Morning Show.

Do you have a patient on your caseload that you're scratching your head about because they've been told they don't have Parkinson's and you're not quite sure what it may be? Join Kay Mayordomo, PT, DPT (@kaym23) as she reviews normal pressure hydrocephalus (NPH).   If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Today, Asif and Ali discuss the career of the legendary singer Billy Joel (1:08). They start off by discussing his accolades, how Joel is compared to his contemporaries and his early years. They then discuss some of his seminal songs that Ali and Asif experienced growing up, including ‘Vienna', ‘Piano Man', ‘My Life', ‘Uptown Girl', and ‘We Didn't Start the Fire'. Then the guys each list their favourite Billy Joel songs.   Joel recently cancelled several tour dates due to normal pressure hydrocephalus, so in the second half, Ali asks Asif about this disorder (31:06). Asif describes what it is and how it differs from hydrocephalus in children. He describes the symptoms, the causes and how common it is. Then, Asif reviews how it is diagnosed and treated.    The opinions expressed are those of the hosts, and do not reflect those of any other organizations. This podcast and website represents the opinions of the hosts. The content here should not be taken as medical advice. The content here is for entertainment and informational purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions.    Music courtesy of Wataboi and 8er41 from Pixabay   Contact us at doctorvcomedian@gmail.com   Follow us on Social media: Twitter: @doctorvcomedian Instagram:  doctorvcomedian   Show Notes: Billy Joel's Life in Photos: https://people.com/billy-joel-life-in-photos-8754102 The Stranger: https://www.nytimes.com/2002/09/15/magazine/the-stranger.html Billy Joel: Still a Stranger: https://www.avclub.com/billy-joel-still-a-stranger-1798214483 Even Billy Joel Mocked ‘We Didn't Start the Fire.' I Loved It: https://www.nytimes.com/2021/08/23/arts/music/billy-joel-we-didnt-start-the-fire.html The 33 Things Wrong With Fall Out Boy's Updated “We Didn't Start the Fire”: https://slate.com/culture/2023/06/we-didnt-start-the-fire-fall-out-boy-lyrics.html What is normal pressure hydrocephalus, the brain disorder affecting Billy Joel? https://www.cbc.ca/news/health/normal-pressure-hydrocephalus-1.7542276 Normal Pressure Hydrocephalus: https://emedicine.medscape.com/article/1150924-overview#a3

Dr. Ravi Johar - United Healthcare - Billy Joel and Hydrocephalus by

Billy Joel recently announced that he has been diagnosed with normal pressure hydrocephalus, or NPH.

Join host Dr. Katie Epstein explores the RadioGaphics article Anatomic Approach to Fetal Hydrocephalus by Griffith et al. Dr. Epstein breaks down how a stepwise, anatomy-based imaging approach can improve diagnosis, guide prenatal counseling, and shape the management of ventriculomegaly. Anatomic Approach to Fetal Hydrocephalus. Griffith et al. RadioGraphics 2025; 45(2):e240071

Dr. Galati starts the program wishing everybody a Happy Memorial Day and to be thankful for those who sacrificed so much for our freedom. He also gives you his thoughts on prostate cancer and screening recommendations after Joe Biden's diagnosis last weekend. We also got news about Billy Joel having hydrocephalus, so Dr. Galati speaks to that as well. He ends by talking about the controversy of food and obesity.  

Moderator: Marian Galovic (Zurich, Switzerland)Guest: Per Kristian Eide (Oslo, Norway)In this episode, moderator Marian Galovich and guest Per Kristian Eide delve into the often overlooked but highly treatable condition of normal pressure hydrocephalus (NPH). Together, they explore the key clinical features of NPH, including its characteristic triad of symptoms, how to differentiate it from other neurodegenerative disorders, and the latest advancements in diagnostic approaches and surgical treatment options such as shunt placement.eanCampus access for Associate Members: If you are a member of a National Neurological Society in Europe, you are most likely already an Associate Member of the EAN and have an account for the eanCampus. If you have provided your email address to your National Neurological Society, it should already be in our database. Here is how you can access the eanCampus as an Associate Member:Enter the eanCampusClick on the Log In ButtonLog in with your MyEAN credentials and make use of the ‘forgot password'-functionality if necessaryIf you have trouble logging in, please get in contact with our Membership department (membership@ean.org) to cross-check if you are listed as an Associate Member to get access to eanCampus.

Episode Summary: Mothers of children with special needs experience a wide range of emotions: fear, disappointment, guilt, grief, despair. They have a yearning for relief but often feel isolated and inadequate as they look at the parenting experience of others. As you pour your energy and resources into raising a special needs child, it’s easy to struggle with feelings of isolation, competition, and overwhelm. For the special needs mom who yearns for community and support on what can be a lonely road, my guest, Carrie Holt, wants to remind you that you are not alone, your best IS good enough, and even on the hard days, there are blessings to be had. In honor of Developmental Disabilities Awareness Month, we’re sharing how to find hope and flourish when parenting a special needs child. Quotables from the episode: I have seen how families lose hope, feel strung out, and all alone living this life of being in and out of the hospital. From the time my son was around 20 months of age, I began volunteering at our local children’s hospital and have been passionate about encouraging others ever since. I was joyfully expecting our third child when at a 20 week ultrasound, our doctor told us something was wrong with the baby. We learned he had Myelomeningocele (Spina Bifida) and Hydrocephalus and would require two life-saving surgeries the first day of his life, with one following a few days later. I read a lot about his condition, grieved, and then planned – trying to control everything. It wasn’t until the last few years, that I have truly grieved that, and have been learning to live in the tension of lament. My son ended up being admitted for 64 days, 30 of those in the PICU. He came home with a trach, ventilator, and g-tube with 16 hours a day/7 days a week of home nursing care. He’s been in and out of the hospital repeatedly and to date has had 64 surgeries. The life of parenting a special needs child is continual, so we are all learning to live in the tension of our kids not being healed and how God is with us in all of this. I’m learning that it’s okay to feel disappointed, to lament that to God, and grieve the hard moments of realizing that my son isn’t going to be like other kids. I’m also trying to help him navigate life’s hard questions: “Why did God allow this? Why didn’t he heal me?” His complex emotions, doubts, and anger over being in a wheelchair has been really hard for us. Do not be afraid of grief. Sometimes we feel like it’s going to drown us, but it’s so important to take our messy emotions to God. It’s okay to take our messy emotions to God – even anger, doubt, and fear, but it’s actually essential to our relationship with God and how He meets us there. Emotions aren’t something we get over, they continually come up again and again, but we’ve learned some strategies to deal with them. Gratefulness, getting quiet, and lament are just a few. I think for me personally, it is learning to take this one day at a time, crying out in the pain when it’s there, and then also remembering that God is in control. It’s also just looking for the little gifts of hope and joy that he gives us on a daily basis. Probably the biggest thing has just been his presence and knowing him in a way that I had not known him if I wasn’t in this. As difficult as pain and suffering is, God has showed me his character and his presence and sometimes it's just that perspective shift of Lord show me you, instead of my eyes being on my pain and my suffering, show me how you've prepared me for this, show me your character, show me your glory, show me your comfort. Jesus wants to be present in your pain. Scripture References: Psalm 40:1-3 ESV I waited patiently for the LORD; he inclined to me and heard my cry. He drew me up from the pit of destruction, out of the miry bog, and set my feet upon a rock, making my steps secure. He put a new song in my mouth, a song of praise to our God. Many will see and fear, and put their trust in the LORD. Lamentations 3:21-26, ESV But this I call to mind, and therefore I have hope: The steadfast love of the LORD never ceases; his mercies never come to an end; they are new every morning; great is your faithfulness. “The LORD is my portion,” says my soul, “therefore I will hope in him.” The LORD is good to those who wait for him, to the soul who seeks him. It is good that one should wait quietly for the salvation of the LORD. Recommended Resources: The Other Side of Special, Navigating the Messy, Emotional, Joy-Filled Life of a Special Needs Mom by Amy J. Brown, Sara Clime, and Carrie M. Holt Sacred Scars: Resting in God’s Promise That Your Past Is Not Wasted by Dr. Michelle Bengtson The Hem of His Garment: Reaching Out To God When Pain Overwhelms by Dr. Michelle Bengtson, winner AWSA 2024 Golden Scroll Christian Living Book of the Year and the 2024 Christian Literary Awards Reader’s Choice Award in the Christian Living and Non-Fiction categories YouVersion 5-Day Devotional Reaching Out To God When Pain Overwhelms Today is Going to be a Good Day: 90 Promises from God to Start Your Day Off Right by Dr. Michelle Bengtson, AWSA Member of the Year, winner of the AWSA 2023 Inspirational Gift Book of the Year Award, the 2024 Christian Literary Awards Reader’s Choice Award in the Devotional category, the 2023 Christian Literary Awards Reader’s Choice Award in four categories, and the Christian Literary Awards Henri Award for Devotionals YouVersion Devotional, Today is Going to be a Good Day version 1 YouVersion Devotional, Today is Going to be a Good Day version 2 Revive & Thrive Women’s Online Conference Revive & Thrive Summit 2 Trusting God through Cancer Summit 1 Trusting God through Cancer Summit 2 Breaking Anxiety’s Grip: How to Reclaim the Peace God Promises by Dr. Michelle Bengtson, winner of the AWSA 2020 Best Christian Living Book First Place, the first place winner for the Best Christian Living Book, the 2020 Carolina Christian Writer’s Conference Contest winner for nonfiction, and winner of the 2021 Christian Literary Award’s Reader’s Choice Award in all four categories for which it was nominated (Non-Fiction Victorious Living, Christian Living Day By Day, Inspirational Breaking Free and Testimonial Justified by Grace categories.) YouVersion Bible Reading Plan for Breaking Anxiety’s Grip Breaking Anxiety’s Grip Free Study Guide Free PDF Resource: How to Fight Fearful/Anxious Thoughts and Win Hope Prevails: Insights from a Doctor’s Personal Journey Through Depression by Dr. Michelle Bengtson, winner of the Christian Literary Award Henri and Reader’s Choice Award Hope Prevails Bible Study by Dr. Michelle Bengtson, winner of the Christian Literary Award Reader’s Choice Award Free Webinar: Help for When You’re Feeling Blue Social Media Links for Host and Guest: Connect with Carrie Holt: Website / Carrie Instagram / Special Moms Instagram / Carrie Facebook / Podcast & Book For more hope, stay connected with Dr. Bengtson at: Order Book Sacred Scars / Order Book The Hem of His Garment / Order Book Today is Going to be a Good Day / Order Book Breaking Anxiety’s Grip / Order Book Hope Prevails / Website / Blog / Facebook / Twitter (@DrMBengtson) / LinkedIn / Instagram / Pinterest / YouTube / Podcast on Apple Guest: Carrie M. Holt is the co-host of the Take Heart Special Moms Podcast, an author and speaker whose passion is to encourage women to flourish in the unexpected. Through her testimony of raising and homeschooling four children, including her son, with medical, mental, and physical disabilities, her desire is for women and mothers to experience the hope we have in trials through the steadfast love of Christ. Her recent book, "The Other Side of Special: Navigating the Messy, Emotional, Joy-Filled Life of a Special Needs Mom," was released May 9th through Revell Publishing. She spent twelve years speaking and advocating through volunteer groups such as Family as Faculty and the Family Advisory Council at Nationwide Children's Hospital, a press conference in Washington D.C., several hospital fundraisers, and an event featuring former Ohio Governor John Kasich. She has also been a guest on various radio shows, including KNEO Author's Corner, Family Life Radio, and Moody Radio, and has spoken for women's events in churches, conferences, and smaller homeschool groups. Hosted By: Dr. Michelle Bengtson Audio Technical Support: Bryce Bengtson Discover more Christian podcasts at lifeaudio.com and inquire about advertising opportunities at lifeaudio.com/contact-us.

Julia, a 26-year-old with T1D, Hydrocephalus, ADHD, Autism, and OCD, discusses life, insulin management, job struggles, and her alert dog. Free Juicebox Community (non Facebook) JUICE CRUISE 2025 Blue Circle Health Eversense CGM Learn about the Medtronic Champions Try delicious AG1 - Drink AG1.com/Juicebox I Have Vision Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Learn about the Dexcom G6 and G7 CGM Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Learn about Touched By Type 1 Take the T1DExchange survey *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  How to listen, disclaimer and more Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find the show and consider leaving a rating and review on Apple Podcasts. Thank you! The Juicebox Podcast is not a charitable organization.  

Syncope Hydrocephalus Coma Final Step type Questions What key symptom differentiates syncope from seizure? What triad is seen in normal pressure hydrocephalus? At what Glasgow Coma Scale (GCS) score is intubation typically required? What is the first-line treatment for increased intracranial pressure in hydrocephalus? What pupil finding suggests opioid toxicity? What test is used to […] The post 126b: Syncope, Hydrocephalus, Coma PANCE Questions appeared first on Physician Assistant Exam Review.

In this heartfelt episode, we sit down with Jasmine Hicks, a devoted mom from Houston, Texas, who shares her powerful story of raising her 8-year-old son, Wesley. Wesley is a true warrior, navigating life with Autism, Epilepsy, Hydrocephalus, ADHD, and Cerebral Palsy. Jasmine's journey is a testament to the strength and resilience it takes to parent a child with special needs. What to Expect: -Jasmine recounts her journey into motherhood, which took an unexpected turn when her water broke at 21 weeks, leading to two months of hospitalization and complete bed rest. -The emotional rollercoaster of welcoming Wesley prematurely and the challenges that followed. -The impact of masking emotions, pretending to be happy outwardly while struggling internally—a reality many parents can relate to. -Jasmine's candid reflection on how her mixed emotions shaped her perspective on motherhood and family. Tune in to hear Jasmine's incredible journey and her advice for navigating life with love, patience, and strength. Connect with Jasmine: Learn more about the Non-Profit Organization "Win All Else Fails" by heading over to www.winallelsefails.org Follow her journey on Instagram: https://www.instagram.com/hickschronicles/ Connect with us and share your thoughts on this episode! Don't forget to subscribe and stay tuned for more empowering stories like Jasmine's. Follow Us: Instagram: https://www.instagram.com/theabmpodcast/ Facebook: https://www.facebook.com/profile.php?id=100095054651586

Today we look at strange letters, signs that you are being gang stalked, and we go on the hunt for the cryptids known as Melon Heads! People get stalked. Trevor Silverwood, for example, received mysterious letters for years. The real question is: are YOU being gang stalked! And then we take a look at the legend of the Melon Heads. Who are the creatures of the night who seek out our tasty flesh? Find out today on Dead Rabbit Radio!   Patreon https://www.patreon.com/user?u=18482113 PayPal Donation Link https://tinyurl.com/mrxe36ph MERCH STORE!!! https://tinyurl.com/y8zam4o2 Amazon Wish List https://www.amazon.com/hz/wishlist/ls/28CIOGSFRUXAD?ref_=wl_share Help Promote Dead Rabbit! Dual Flyer https://i.imgur.com/OhuoI2v.jpg "As Above" Flyer https://i.imgur.com/yobMtUp.jpg “Alien Flyer” By TVP VT U https://imgur.com/gallery/aPN1Fnw “QR Code Flyer” by Finn https://imgur.com/a/aYYUMAh Links: Trevor Silverwood and the phantom writer https://www.unexplained-mysteries.com/forum/topic/181722-trevor-silverwood-and-the-phantom-writer/ Strange Letters https://forums.forteana.org/index.php?threads/strange-letters.9294/ How do you know if you're being gang stalked? https://www.quora.com/How-do-you-know-if-you-re-being-gang-stalked Crazy Woman Thinks Mailman Is Stalking Her https://www.youtube.com/watch?v=dOCyzG4BktQ Melon heads https://en.wikipedia.org/wiki/Melon_heads Hydrocephalus https://en.wikipedia.org/wiki/Hydrocephalus Dorr E. Felt Mansion https://en.wikipedia.org/wiki/Dorr_E._Felt_Mansion Melonheads Creep Through the Ohio Woods at Night http://www.weirdus.com/states/ohio/fabled_people_and_places/melonheads/index.php Owyhee Mountain Dwarves https://www.hauntedplaces.org/item/owyhee-mountain-dwarves/   ------------------------------------------------ Logo Art By Ash Black Opening Song: "Atlantis Attacks" Closing Song: "Bella Royale" Music By Simple Rabbitron 3000 created by Eerbud Thanks to Chris K, Founder Of The Golden Rabbit Brigade Dead Rabbit Archivist Some Weirdo On Twitter AKA Jack YouTube Champ Stewart Meatball The Haunted Mic Arm provided by Chyme Chili Discord Mods: Mason Forever Fluffle: Cantillions, Samson Foreign Correspondent: Fabio Nerbon http://www.DeadRabbit.com Email: DeadRabbitRadio@gmail.com Facebook: www.Facebook.com/DeadRabbitRadio TikTok: https://www.tiktok.com/@deadrabbitradio Dead Rabbit Radio Subreddit: https://www.reddit.com/r/DeadRabbitRadio/ Paranormal News Subreddit: https://www.reddit.com/r/ParanormalNews/ Mailing Address Jason Carpenter PO Box 1363 Hood River, OR 97031 Paranormal, Conspiracy, and True Crime news as it happens! Jason Carpenter breaks the stories they'll be talking about tomorrow, assuming the world doesn't end today. All Contents Of This Podcast Copyright Jason Carpenter 2018 - 2025  

Syncope, Hydrocephalus, and Coma Syncope Transient loss of consciousness due to global cerebral hypoperfusion, often with rapid onset, brief duration, and spontaneous recovery A key differential in cerebrovascular cases, distinct from stroke, TIA, and seizures Clinical Presentation Preceding Symptoms: Dizziness, lightheadedness, nausea, pallor, diaphoresis Triggers: Prolonged standing, vasovagal (emotional stress) Orthostatic hypotension (sudden positional changes) […] The post 126 Syncope, Coma & Master Class Tonight!  appeared first on Physician Assistant Exam Review.

What if you could recognize early signs of health deterioration before it turns into a crisis? Join us in a conversation with the inspiring couple, Jeff and Catherine Pearson, as they share their remarkable journey navigating life with hydrocephalus. Jeff, who has managed this condition since birth, and Catherine, his devoted caregiver, reveal their story of resilience through multiple surgeries and health challenges. Learn how their nonprofit, Hydro With Hope, and their online initiative, Invisible Condition University, provide vital resources and support for those affected by invisible conditions.Our discussion takes a deep dive into understanding the critical importance of proactive healthcare and the emotional and financial toll of unexpected medical emergencies. We explore Jeff's experience with sudden brain surgery and the lessons learned about listening to your body and recognizing symptoms early. Catherine shares her invaluable insights as a caregiver, emphasizing the importance of a supportive network. Through personal anecdotes, she illustrates the nuances of differentiating between various types of discomfort and the significance of addressing both physical and emotional needs.We also explore the Pearsons' passion for fostering community and collaboration in healthcare. By integrating Western and alternative medicine, they advocate for a cooperative approach to care. Their creation of "My Hydro Warrior Story" serves as a testament to the power of storytelling and shared experiences in building a strong support system. Their dedication to empowering families with chronic conditions shines through as they share strategies for balancing family life while navigating the complexities of healthcare. Get ready to be inspired by their unwavering commitment to making a difference in the world of invisible conditions.To watch our TV show Invisible Condition:https://watch.e360tv.com/content/sc_29490_16217Invisible Condition broadcasts LIVE every TUESDAY & FRIDAY at 10:00an MT and is available on demandon FB & YouTube immediately after the LIVE broadcast has concluded. Available on the e360tv siteabout a day later.Watch Invisible Condition LIVE on Facebook:https://www.facebook.com/profile.php?id=100091481468419You can watch the show here and chat with us LIVE during the show)Watch Invisible Condition LIVE on YouTube:https://www.youtube.com/@InvisibleCondition/streamsTo be considered as a guest for Invisible Condition, schedule a short discovery call with Jeff:https://api.totalallinonesolutions.com/widget/bookings/invisibleconditiontvTo join our growing community at Invisible Condition University:www.MyFreeGiftFromJeff.comSend us a text Hi, Jen here! We are so glad to have you back. I want to personally thank those that have signed up with Rare Patient Voice recently. We love your support of the podcast, and this is another way that you can by signing up with Rare Patient Voice through our referral link. Remember, we're here to support you every step of the way. Support the showSupport:https://rarepatientvoice.com/Myspooniesisters/https://www.etsy.com/shop/MySpoonieSistershttps://www.graceandable.com/?bg_ref=980:nzTyG6c9zK (Use code GAJen10)Website:https://myspooniesisters.com/

In this episode, host Ken Vinacco talks to guest Kristina Vaughn to discuss the role of physical therapists working with individuals with normal pressure hydrocephalus (NPH). NPH is a condition that leads to excess accumulation of cerebrospinal fluid in ventricles of the brain. This  can lead to gait abnormalities, cognitive changes, and urinary incontinence. Ken and Kristina discuss how to differentiate from other neurologic diagnoses and what PTs can do to in the clinic or as a member of a multi-disciplinary NPH clinic team.  The Degenerative Diseases Special Interest Group is part of the Academy of Neurologic Physical Therapy – www.neuroPT.org  For questions about this podcast, please contact neuroddsig@gmail.com. Show notes available: https://app.box.com/s/zzlyovhljhzm6qscq11lrfbp9v8z40ev

In this episode, we discuss the case of a 15-year-old girl who presents with progressive headache, nausea, vomiting, and difficulty ambulating. Her condition rapidly evolves into altered mental status and severe hydrocephalus, leading to a compelling discussion about the evaluation, diagnosis, and management of hydrocephalus in pediatric patients.We break down the case into key elements:A comprehensive look at acute hydrocephalus, including its pathophysiology and causesEpidemiological insights, clinical presentation, and diagnostic approachesManagement strategies, including temporary and permanent CSF diversion techniquesA review of complications related to shunts and endoscopic third ventriculostomyKey Case Highlights:Patient Presentation:A 15-year-old girl with a 3-day history of worsening headaches, nausea, vomiting, and difficulty walkingAltered mental status and bradycardia upon PICU admissionCT scan revealed severe hydrocephalus without a clear mass lesionManagement Steps in the PICU:Hypertonic saline bolus improved her mental status and pupillary reactionsNeurosurgery consultation recommended MRI and close neuro checksInitial management included dexamethasone, keeping the patient NPO, and hourly neuro assessmentsDifferential Diagnosis:Obstructive (non-communicating) vs. non-obstructive (communicating) hydrocephalusConsideration of alternative diagnoses like intracranial hemorrhage and idiopathic intracranial hypertensionEpisode Learning Points:Hydrocephalus Overview:Abnormal CSF buildup in the ventricles leading to increased intracranial pressure (ICP)Key distinctions between obstructive and non-obstructive typesEpidemiology and Risk Factors:Congenital causes include genetic syndromes, neural tube defects, and Chiari malformationsAcquired causes: post-hemorrhagic hydrocephalus (e.g., from IVH in preemies), infections like TB meningitis, and brain tumorsClinical Presentation:Infants: Bulging fontanelles, sunsetting eyes, irritabilityOlder children: Headaches, vomiting, papilledema, and gait disturbancesManagement Framework:Temporary CSF diversion via external ventricular drains (EVD) or lumbar cathetersPermanent interventions include VP shunts and endoscopic third ventriculostomy (ETV)Complications of Shunts and ETV:Shunt infections, malfunctions, over-drainage, and migrationETV-specific risks, including delayed failure years post-procedureClinical Pearl:Communicating hydrocephalus involves symmetric ventricular enlargement and is often linked to inflammatory or post-treatment changes affecting CSF reabsorption.Hosts' Takeaway Points:Dr. Pradip Kamat emphasizes the importance of timely recognition and intervention in hydrocephalus to prevent complications like brain herniation.Dr. Rahul Damania highlights the need for meticulous neurological checks in PICU patients and an individualized approach to treatment.Resources Mentioned:Hydrocephalus Clinical Research Network guidelines.Recent studies on ETV outcomes in pediatric populations.Call to Action:If you enjoyed this discussion, please subscribe to PICU Doc On Call and leave a review. Have a topic you'd like us to cover? Reach out to us via email or on social media!Follow Us:Twitter: @PICUDocOnCallEmail:

Not only do Becca Ingersoll's twin boys Lincoln and Logan have special needs, Lincoln was diagnosed with B Cell Acute Lymphoblastic Leukemia when he was 3 years old in January of 2020. Lincoln also has Cerebral Palsy, Hydrocephalus, and Autism. Becca will talk about the very difficult and tricky road that she and her husband Josh have been navigating for the past 7 years, and will also discuss  her work as an activist and advocate in the cause of Pediatric Cancer. 

One thing is certain about fishermen and fisherwomen, we all enjoy fishing for a cause and getting the competitive juices flowing. This week we had the fortune of supporting and participating in the 2nd Annual No BS Inshore Slam tourney out of Georgetown, S.C. The crew put three teams together to fish and we decided to record our radio show on site at the captains meeting. The Mears family founded this event to raise funds to help with research and treatments for Hydrocephalus. Also known as water on the brain, this is a condition in which there is an accumulation of cerebrospinal fluid within the brain. Funds from this event will go to help with research as well as helping provide treatment for patients that will not include braind surgery(BS). Our guests this week included some of our normal hosts as well as a few surprise guests. We hope you are enjoyinf a successful fall on the water or in the woods and remember to tag us in your prized pictures with your catches or harvests. visit www.trilogyoutdoorsmedia.com for more info on current events. Become a supporter of this podcast: https://www.spreaker.com/podcast/trilogy-outdoors--5441492/support.

During this episode of Making the Rounds, we'll discuss normal pressure hydrocephalus (NPH), how it's diagnosed as well as challenges with the diagnostic process, non-surgical treatment options and surgical interventions. We'll also share information about the new Center for Normal Pressure Hydrocephalus at Banner Health in Phoenix. You'll hear from Dr. Robert Bina, a neurosurgeon specializing in epilepsy surgery and restorative neurosurgery at Banner - University Medicine Phoenix and assistant professor of neurosurgery at the University of Arizona College of Medicine - Phoenix. To learn more about this topic or other neurological related services provided at Banner Health, please visit bannerhealth.com/brainandspine.

Normal Pressure Hydrocephalus is one of a few reversible causes of dementia. Dr. Garni Barkhoudarian, director of the Pacific Adult Hydrocephalus Center, briefly describes the symptoms, diagnosis and treatment of this condition.

Send us a Text Message.Had the pleasure of speaking with independent wrestling promoter James Toney! On episode 117, we discussed overcoming bullying, getting involved in both boxing and wrestling, starting his own promotion, raising awareness about Hydrocephalus, and more. You can find out more about Toney here:https://www.facebook.com/JamTone1Check out Precision Kombat League on YouTube:https://www.youtube.com/@totalprecisionkombat1599Are you a pro wrestler and have done community service and/or charity work? E-mail the podcast at wrestlingwithheart@yahoo.com and tell us if you would be interested in being interviewed.Follow us on:Facebook: Wrestling with Heart with Stanley KarrX: @wwhwskInstagram: @wrestlingwithheartThreads: @wrestlingwithheartHear Wrestling with Heart on Apple Podcasts: https://podcasts.apple.com/us/podcast...Hear Wrestling with Heart on Spotify: https://open.spotify.com/show/46cviL5...Hear Wrestling with Heart on iHeartRadio: https://www.iheart.com/podcast/269-wr...Hear Wrestling with Heart on Google Podcasts: https://podcasts.google.com/search/Wr...Donate to my Patreon and subscribe to my content here: https://www.patreon.com/user?u=84502525Support the Show.

This week we are honored to welcome pediatric neurosurgeon, Dr. David Bonda to Ask Dr Jessica! We have an indepth conversation about head injuries, large and small head sizes, hydrocephalus, epilepsy, recent advancements in his field of medicine, and more! Parents, you'll enjoy Dr Bonda---he's articulate, thoughtful, and you'll learn so much! Dr. Bonda is a native of Cleveland, Ohio. He received his BA in neuroscience at The University of Pennsylvania and his MD at Case Western Reserve University School of Medicine. After completing his neurosurgical residency training at The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, he went on to complete his fellowship in pediatric neurosurgery at The University of Washington/Seattle Children's Hospital. At Cedars-Sinai/Guerin Children's, Dr. Bonda runs the surgical epilepsy program along with pediatric epileptologist Dr. Debbie Holder where they provide comprehensive epilepsy care for patients with drug resistant epilepsy.Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com. Follow her on Instagram: @AskDrJessicaSubscribe to her YouTube channel! Ask Dr JessicaSubscribe to this podcast: Ask Dr JessicaSubscribe to her mailing list: www.askdrjessicamd.comThe information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Golf to End Hydrocephalus comes to West Palm full 526 Wed, 31 Jul 2024 23:46:45 +0000 mdZ7ut91WmklrSeZHHiVhcNtkOOuI2Bl ESPN West Palm Tonight Golf to End Hydrocephalus comes to West Palm ESPN West Palm Tonight 2021, Good Karma Brands, LLC

Rachel is a certified Family Nurse Practitioner with over 13 years of experience working at one the most prestigious hospitals in the world. She is a former critical care nurse and nurse educator; teaching in both the clinical and classroom setting. After noticing changes in her infant son's behavior, Rachel took matters into her own hands and began to get a second (and third) opinion to receive the devastating news that he had Hydrocephalus, an incurable brain disease that is caused by excessive fluid buildup inside the brain. Rachel now has this inside and outside perspectives of the healthcare world to help shine a light on boundaries to set and ways to advocate for yourself and your loved ones. Key Takeaways [00:03:17] Trusting medical professionals vs. self-advocating [00:09:17] Diagnosis impact [00:14:32] Seeking multiple medical opinions [00:19:13] Overcoming challenges with neuroplasticity [00:23:24] Importance of a team you can trust [00:26:30] Setting boundaries with medical providers [00:33:13] Mishandling of care [00:37:26] Understanding empathy in healthcare [00:41:09] Limitations of medical providers [00:46:09] Hope for Hydro Where to Find Rachel LinkedIn – Rachel Malec Facebook – Rachel Malec Instagram – @RachelMalec Website – HopeForHydro.Org How to find us - Visit our website – hardnopodcast.com – for show notes, which include links to books and other helpful resources. Like what you hear? Please subscribe, rate and review so others can find us, and make sure to follow us on social media. We're @hardnopodcast on Instagram, Facebook, LinkedIn & YouTube.

This is the third in a special series of interviews within the SFN Dad To Dad Podcasts to be known as the SFN Mastermind Group Monday Podcasts.  Each Monday host David Hirsch will interview one of the SFN Mastermind Group dads on the impact the mastermind group has had on him and the wellbeing of his family.  This Monday's guest is Jeff Johnson of Anderson, SC who works as a meat cutter at Publix Supermarkets and father of two boys, including one with profound disability.Jeff and his wife, Michelle, have been married for 40 years and are the proud parents of two adult children; Michael (29) and Daniel (26) who has Hydrocephalus and Encephalocele is non-verbal, non-ambulatory and ventilator dependent. Jeff has been part of the Wednesday night SFN Mastermind Group, has attended the annual weekend SFN Mastermind Group Retreats and was featured in episode #155 of the SFN Dad To Dad Podcast in June of 2021.Show Notes -Phone – 864-444-8170 Email – jj841916@gmail.comSFN Dad To Dad Podcast – https://21stcenturydads.org/155-jeff-johnson-of-anderson-sc-father-of-two-including-a-son-with-hydrocephalus-encephalocele/Jeff's Favorite Books Reviewed As Part Of The Mastermind Group – The Ultimate Gift, by Jim StovallThinking In Pictures, by Dr. Temple GrandinThe Leader Within Us, by Warren RustandAbout the SFN Mastermind Group – WHAT- SFN Mastermind Group dads meet weekly by Zoom for 75 minutes. Each meeting:◦            starts with a round of wins from the past week,◦            includes a discussion of the current book (6 per year) being reviewed,◦            has two Dad-In-The-Middle sessions for dads to share a challenge, and◦            ends with a recap and look at the week ahead. WHO - SFN Mastermind Group Dads are those:◦            seeking meaningful friendships with like-minded dads,◦            willing to invest their time and make a financial commitment,◦            looking for a safe place to be open and authentic, and◦            who realize seeking advice is a strength, not a weakness.  WHY - SFN Mastermind Group Dads benefit by:◦            realizing they are NOT alone◦            having better relationships with their spouse,◦            developing improved understandings of their child(ren),◦            tapping into the experience and wisdom of others,◦            getting weekly encouragement from like-minded dads, and◦            creating a pathway to become the best version of themselves21st Century Dads Foundation is looking to provide 100 special needs fathers with the opportunity to be part of the class of 2024 Mastermind Group.   Curious to learn more?Are you looking to meet like-minded dads?Do you feel like something is missing?  SFN Mastermind Group FAQs - https://21stcenturydads.org/sfn-mastermind-group/  Schedule A Call - https://21stcenturydads.org/sfn-mastermind-group-inquiry-form/

Dan McCoy's journey embodies resilience and triumph. Despite being born with Spina Bifida and Hydrocephalus, he soared to victory with Team USA's Paralympic Sled Hockey Team in 2014, securing a cherished Gold Medal.    This triumph ignited his passion for fitness and nutrition, driving him to empower others, irrespective of their challenges, to embrace healthier lifestyles. As a certified personal trainer,     Dan dedicates himself to guiding individuals towards their fitness goals with compassion and understanding.Touched by this episode?  Donate to LYM Podcast:https://www.buymeacoffee.com/leaveyourmarkReach out to us on our website!https://www.leaveyourmarkvc.com/contactAll LYM online pages:www.Linktr.ee/VinniecVince Cortese, Author: My Story about Courage and FaithBad Days are Really Good Days in Disguisehttps://amzn.to/3TB6VBPJoin LYM Newsletter:http://bit.ly/JoinMEonLYMWatch on YouTubeSponsors of this episode:Affiliate Link in this episode:Support the Show.

When Jessica (Jessi) Cohen's routine ultrasound revealed a reality no parent should ever confront—her unborn baby, diagnosed with severe hydrocephalus and missing brain parts—their story took a turn towards the extraordinary. This episode invites you to walk alongside Jessi as she recounts the anguish and hope that defined her journey from that life-altering diagnosis to witnessing her daughter, Naysa Angélica's (her name means miracle of God, messenger of God), astonishing defiance of medical expectations. Through this conversation we discover a mother's undying faith and the deep strength she drew from it amidst the toughest decisions a parent could face.Navigating a path seeped with medical opinions that often echoed hopelessness, Jessi's story sheds light on the often-clinical detachment and the contrasting support through select healthcare specialists. Her high-risk pregnancy, marked by anxiety-inducing consultations and a prenatal supplement discovery, Jessi will not just touch your heart, but also testify to the profound impact of faith. Every update, every doctor's visit, and the eventual emergency C-section—a moment of crisis enveloped in prayer and song—reminds us of the immeasurable depths of God's grace in life's toughest times.We end this episode by sharing in the joy of Naysa Angélica's progress, a living testament to the miraculous health, found in God our Healer. Jessi's story doesn't end with a miraculous birth; it's an ongoing victory of overcoming the odds, from Naysa's achievements in crawling and speaking to the prospect of a bright future. And for those seeking support on their own healing journeys, we share the hope found in HealingStrong—a faith-based cancer and disease support community that embodies the very essence of hope and empowerment, reminding us all that even amidst life's greatest trials, we are never alone.We know this episode will bless you!Visit our Bible Study Plans mentioned in the interview:YouVersion Bible PlansTo download for free any of the HealingStrong Bible plans, please visit: healingstrong.org/refreshHealingStrong's mission is to educate, equip and empower our group leaders and group participants through their journey with cancer or other chronic illnesses, and know there is HOPE. We bring this hope through educational materials, webinars, guest speakers, conferences, community small group support and more.Please consider supporting our mission by becoming a part of our Membership Program, as a monthly donor.When you do, you will receive additional resources such as: webinars, access to ALL our past and most recent conference videos, downloadables and more, as a bonus.To learn more, head to the HealingStrong Membership Program link below: Membership Program

You'll definitely run into questions about CSF. In this episode, Bilal Rana will go over some must know points about communicating and noncommunicating hydrocephalus, as well as hydrocephalus ex vacuo.

What do you do when a teenager with odd (and concerning) neurological symptoms walks into you ER and how do you apply the PEM Rules to work him up step by step?

Episode 164: More Than Just A HeadacheDr. Song presents a case of a subacute headache that required an extensive workup and multiple visits to the hospital and clinic to get a diagnosis. Dr. Arreaza added comments about common causes of subacute headaches.    Written by Zheng (David) Song, MD. Editing and comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction to the episode: We are happy to announce the class of 2027 of the Rio Bravo / Clinica Sierra Vista Family Medicine Residency Program. Our new group will be (in alphabetical order): Ahamed El Azzih Mohamad, Basiru Omisore, Kenechukwu Nweke, Mariano Rubio, Nariman Almnini, Patrick De Luna, Sheila Toro, and Syed Hasan. We welcome all of you. We hope you can enjoy 3 enriching and fulfilling years. During this episode, you will hear a conversation between Dr. Arreaza and Dr. Song. Some elements of the case have been modified or omitted to protect the patient's confidentiality. 1. Introduction to the case: Headache. A 40-year-old male with no significant PMH presents to the ED in a local hospital due to over a month history of headaches. Per the patient, headaches usually start from the bilateral temporal side as a tingling sensation, and it goes to the frontal part of the head and then moves up to the top of the head. 8 out of 10 severities were the worst. Pt reports sometimes hypersensitivity to outdoor sunlight but not indoor light. OTC ibuprofen was helpful for the headache, but the headache always came back after a few hours. The patient states that if he gets up too quickly, he feels slightly dizzy sometimes, but it is only for a short period of time. There was only one episode of double vision lasting a few seconds about 2 weeks ago but otherwise, the patient denies any other neurological symptom. He does not know the cause of the headache and denies any similar history of headaches in the past. The patient denies any vomiting, chest pain, shortness of breath, cough, abdominal pain, or joint pain. The patient further denies any recent traveling or sick contact. He does not take any chronic medication. The patient denies any previous surgical history. He does not smoke, drink, or use illicit drugs. What are your differential diagnoses at this moment? Primary care: Tension headache, migraines, chronic sinusitis, and more.2. Continuation of the case: Fever and immigrant.Upon further inquiries, the patient endorses frequent “low-grade fever” but he did not check his temperature. He denies any significant fatigue, night sweats, or weight loss. He migrated from Bolivia to the U.S. 12 years ago and has been working as a farm worker in California for the past 10 years. He is married. His wife and daughter are at home in Bolivia. He is currently living with friends. He is not sexually active at this moment and denies having any sexual partners. Differential diagnoses at this moment?  Tension headache, migraine, infections, autoimmune disease, neurocysticercosis. 3. Continuation of the case: Antibiotics and eosinophilia. As we kept asking for more information, the patient remembered he visited a clinic about four months ago for a dry cough and was told he had bronchitis and was given antibiotics and the cough got better after that. He went to another local hospital ED one month after that because the cough came back, now with occasional phlegm and at that time he also noticed two “bumps” on his face but nothing significant. After a CXR at the ED, the patient was diagnosed with community-acquired pneumonia and sent home with cough medication and another course of antibiotics. His cough improved after the second round of antibiotics. We later found on the medical record that the CXR showed “mild coarse perihilar interstitial infiltrates of unknown acuity”. His blood works at the ED showed WBC 15.2, with lymphocyte 21.2%, monocyte 10.1%, neutrophil 61.7%, eosinophil 5.9% (normally 1-4%), normal kidney, liver functions, and electrolytes, and prescribed with benzonatate 100mg TID and doxycycline 100mg bid for 10 days. He went to the same ED one month before he saw us for headache and fever (we reviewed his EMR, and temp was 99.8F at the ED). After normal CBC, CMP and chest x-ray. The patient was diagnosed with a viral illness and discharged home with ibuprofen 400mg q8h.Due to the ongoing symptoms of headache and fever, the patient went back to the same clinic he went to four months ago for a dry cough and requested a complete physical and blood work. The patient was told he had a viral condition and was sent home with oseltamivir (Tamiflu®) for five days. However, the provider did order some blood work for him. Differential diagnoses at this moment?  Patients with subacute meningitis typically have an unrelenting headache, stiff neck, low-grade fever, and lethargy for days to several weeks before they present for evaluation. Cranial nerve abnormalities and night sweats may be present. Common causative organisms include M. tuberculosis, C. neoformans, H. capsulatum, C. immitis, and T. pallidum. At his physical exam visit, the patient actually asked the provider specifically to check him for coccidiomycosis because of his job as a farm worker and he heard from his friends that the infection rate is pretty high in the Central Valley of California. His serum cocci serology panel showed positive IGG and IGM with CF titer of 1:128. His HIV, syphilis, HCV, HBV are all negative. The patient was told by that clinic to come to ED due to his history of headache, fever, and very high serum coccidiomycosis titer.  The senior and resident intern were on the night shift that night and we were contacted by the ED provider at around 9:30 pm for this patient. When reviewing his ED record, his vitals were totally normal at the ED, the preliminary ED non-contrast head CT showed no acute intracranial abnormality. A lumbar puncture was performed by the ED provider, which showed WBCs (505 - 71%N, 20%L, 7%M), RBC (1), glucose (19), and protein (200). CSF: High Leukocytes, low glucose, and high protein.On the physical exam, the patient was pleasant and cooperative, he was A&O x 4, he had a normal examination except for two brown healing small nodules on his forehead and left cheek and slight neck stiffness. At that point, we knew the patient most likely had fungal meningitis by cocci except for the predominant WBC in his CSF fluid was neutrophil not the more typical picture of lymphocyte dominant. And because of his very benign presentation and subacute history, we were not 100% sure if we had a strong reason to admit this patient. We thought this patient could be managed as an outpatient with oral fluconazole and referred to infectious disease and neurology. 4. Continuation of case: Admission to the hospital.Looking back, one thing that was overlooked while checking this patient in the ED was the LP opening pressure. Later, the open pressure was reported as 340mm H2O (very high). The good thing was, after speaking to the ED attending and our attending, the patient was admitted to the hospital and started on oral fluconazole.  Three hours after the admission, a rapid response was called on him. While the floor nurses were doing their check-in physical examination, the patient had a 5-minute episode of seizure-like activity which included bilateral tonic arm/hand movements, eye deviation to the left, LOC unresponsive to sternal rub, and the patient desaturated to 77%. He eventually regained consciousness after the seizure and pulse oximetry increased to 100% on room air. The patient was started on Keppra and seen by a neurologist the following day. His 12-hour EEG was normal, but his head MRI showed “diffuse thickening and nodularity of the basal meninges are seen demonstrating enhancement, suggesting chronic meningitis, possibly related to cocci. Other etiologies including sarcoidosis and TB meningitis and/or infiltration by metastatic process/lymphoma are not excluded. The ventricles are slightly prominent in size”. MRI of the cervical, thoracic, and lumbar spines also showed extensive diffuse leptomeningeal thickening, extensive meningitis, and nodular dural thickening. Also, his chest x-ray showed “some heterogeneity and remodeling of the distal half of the left clavicle. Metabolic bone disease, infectious etiology and/old trauma considered”. This could also be due to disseminated cocci infection. The infectious disease doctor saw this patient and recommended continuing with fluconazole, serial LPs until opening pressure is less than 250 mmH2O and neurosurgery consultation for possible VP shunt placement. The neurologist recommended the patient continue with Keppra indefinitely in the context of structural brain damage secondary to cocci meningitis.Take home points: Suspect cocci meningitis in patients with subacute headache associated with respiratory symptoms, new skin lesions, photophobia, neck stiffness, nausea, vomiting, eosinophilia, erythema nodosum (painful nodules on the anterior aspect of legs). Other symptoms to look for include arthralgias, particularly of the ankles, knees, and wrists.____________________Brief summary of coccidiomycosis. Etiology Coccidioidomycosis, commonly known as Valley fever, is caused by dimorphic soil-dwelling fungi of the genus Coccidioides (C. immitis and C. posadasii). They are indistinguishable in clinical presentation and routine laboratory test results.1, 2, 3, 5Epidemiology In the United States, endemic areas include the southern portion of the San Joaquin Valley of California and the south-central region of Arizona. However, infection may be acquired in other areas of the southwestern United States, including the southern coastal counties in California, southern Nevada, southwestern Utah, southern New Mexico, and western Texas (including the Rio Grande Valley). There are also cases in eastern Washington state and in northeastern Utah. Outside the United States, coccidioidomycosis is endemic to northern Mexico as well as to localized regions of Central and South America.1, 2Overall, the incidence within the United States increased substantially over the 1998-2019, most of that increase occurred in south-central Arizona and in the southern San Joaquin Valley of California. From 1998 to2019, reported cases in California increased from 719 to 9004.1, 6The risk of infection is increased by direct exposure to soil harboring Coccidioides. Past outbreaks have occurred in military trainees, archaeologists, construction or agricultural workers, people exposed to earthquakes or dust storms. However, in endemic areas, many cases of Coccidioides infection occur without obvious soil or dust exposure and are not associated with outbreaks. Change in population, climate change, urbanization and construction activities, and increased awareness and reporting, are possible contributing factors.1, 2, 5 Pathology In the soil, Coccidioides organisms exist as filamentous molds. Small structures called arthroconidia from the hyphae may become airborne for extended periods. Arthroconidia are usually 3-5 μm—small enough to evade bronchial tree mucosal mechanical defenses and reach deep into the lungs.1, 3Once inhaled by a susceptible host into the lung, the arthroconidia develop into spherules (theparasitic existence in a host), which are unique to Coccidioides. Endospores from ruptured spherules can themselves develop into spherules, thus propagating infection locally.1, 3, 5Although rare cases of solid organ donor-derived or fomite transmitted infections have been reported, coccidioidomycosis does not occur in person-to-person or zoonotic contagion, and transplacental infection in humans has never been documented.2, 5Cellular immunity plays a crucial role in the host's control of coccidioidomycosis. Among individuals with decreased cellular immunity, Coccidioides may spread locally or hematogenously after an initial symptomatic or asymptomatic pulmonary infection to extrathoracic organs.1, 3, 7Clinical manifestationThe majority of infected individuals (about 60%) are completely asymptomatic. Symptomatic persons (40% of cases) have symptoms that are related principally to pulmonary infection, including cough, dyspnea, and pleuritic chest pain. Some patients may also experience fever, headache (common finding in early-stage infection and does not represent meningitis), fatigue, night sweats, rash, myalgia.1, 2, 3, 5In most patients, primary pulmonary coccidioidomycosis usually resolves in weeks without sequelae and lifelong immunity to reinfection. However, some patients may develop chronic pulmonary complications, such as nodules or pulmonary cavities, or chronic fibrocavitary pneumonia. Some individuals with intense environmental exposure or profoundly suppressed cellular immunity (e.g., in patients with AIDS) may develop a primary pneumonia with diffuse reticulonodular pulmonary process in association with dyspnea and fever.1, 3, 5Fewer than 1% of infected individuals develop extrathoracic disseminated coccidioidal infection. Common sites for dissemination include joints and bones, skin and soft tissues, and meninges. One site or multiple anatomic foci may be affected. 1, 2, 3, 7It is estimated that coccidioidal meningitis, the most lethal complication of coccidioidomycosis, affects only 0.1% of all exposed individuals. Patients with coccidioidal meningitis usually present with a persistent headache (rather than a self-limited headache in some patients with primary pulmonary infection), with nausea and vomiting, and sometimes vision change. Some may also develop altered mental status and confusion. Meningismus such as nuchal rigidity, if present, is not severe.Hydrocephalus and cerebral infarction may develop in some cases. Papilledema is more commonly observed in pediatric patients.1, 3, 4, 5, 7When meningitis develops, most patients may not have any respiratory symptoms nor radiographic manifestation of pulmonary infection. However, a large number of these individuals also present with other extrathoracic lesions.7DiagnosisAlthough early diagnosis carries obvious benefits for patients and the health care systems as a whole (e.g., decreases patient anxiety, reduces the cost of expensive and invasive tests, removes the temptation for empirical antibacterial or antiviral treatments, and allows for early detection of complications), considerable diagnostic delays up to several weeks to months are common in both endemic areas and non-endemic areas.3, 7 Most symptomatic persons with coccidioidal infection present with primarily pulmonary symptoms and are often misdiagnosed as community-acquired bacterial pneumonia and treated with antibiotics. In endemic areas like south-central Arizona, previous studies found up to 29% of community-acquired pneumonia is caused by coccidioidomycosis. Healthcare providers thus should maintain a high clinical suspicion for coccidioidomycosis when evaluating persons with pneumonia who live in or have traveled to endemic areas recently. Elevated peripheral-blood eosinophilia of over 5%, hilar or mediastinal adenopathy on chest radiography, marked fatigue, and failure to improve with antibiotic therapy should prompt suspicion and testing for infection with coccidioidomycosis in endemic areas.1, 3, 5Serological testing plays an important role in establishing a diagnosis of coccidioidomycosis. Enzyme immunoassay (EIA) to detect IgM and IgG antibodies is highly sensitive and therefore commonly used as the screening tool. Immunodiffusion is more specific but less sensitive than enzyme immunoassay. It is used to confirm the diagnosis of positive EIA test results. Complement fixing (CF) test, which indirectly detects the presence of coccidioidal antibodies by testing the consumption of serum complement, are expressed as titers. Serial measurements of titers are of not only diagnostic but also prognostic value.1, 2, 3, 5Other methods, including culture, microscopic, or polymerase chain reaction (PCR) exam on tissue or respiratory specimens, are limited by their availability, sample obtaining and handling, or lack of sufficient evaluation.1, 2, 3, 5Cerebrospinal fluid (CSF) examination in coccidioidal meningitis usually demonstrates lymphocyte dominated elevation of leukocytes, although polymorphonuclear leukocyte dominance can also be seen in the early stage of the infection. Profound hypoglycorrhachia and elevated protein levels in CSF examination are also very common in coccidioidal meningitis.1, 7Although isolating Coccidioides from CSF or other CNS specimens are diagnostic for coccidioidal meningitis, in practice, diagnoses are often made based on the combination of clinical presentation, CSF examination that suggesting fungal infection, and positive Coccidioides antibodies found in CSF.7Imaging, especially enhanced magnetic resonance imaging (MRI), can help in diagnosing coccidioidal meningitis. Basilar leptomeningeal enhancement is a more common finding even though hydrocephalus, cerebral infarction, and vertebral artery aneurysm can also be seen.7TreatmentMost patients with focal primary pulmonary coccidioidomycosis do not require antifungal therapy. According to 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline, antifungal therapy should be considered in patients with concurrent immunosuppression that adversely affect cellular immunity (e.g., organ transplant patients, AIDS in HIV-infected patients, and patients receiving anti–tumor necrosis factor therapy) and those with significantly debilitating illness, extensive pulmonary involvement, with concurrent diabetes, pregnant women, or who are otherwise frail because of age or comorbidities. Some experts would also include African or Filipino ancestry as indications for treatment. Conversely, humoral immunity comprise splenectomy, hypocomplementemia, or neutrophil dysfunction syndromes are not major risk factors for this disease.1, 2, 3, 4, 5Triazole antifungals (fluconazole or itraconazole) are currently considered as the first-line medications used to treat most cases of coccidioidomycosis. Amphotericin B is reserved for only the most severe cases of dissemination and patients with coccidioidal meningitis in whom triazole antifungal therapy has failed. It is also the choice of therapy for coccidioidomycosis in pregnant women during the first trimester because of the possible teratogenic effect of high-dose triazole therapy during this period of time.1, 3, 4, 5Treating coccidioidal meningitis (CM) poses a special challenge because untreated meningitis is nearly always fatal. Lifelong therapy is recommended for CM because the majority 80% patients with CM experience relapse when therapy is stopped despite initial response to antifungal treatment. Shunting of CSF is required in cases of meningitis complicated by hydrocephalus.1, 3, 4, 5, 7Prevention Avoidance of direct contact with contaminated soil in endemic areas (e.g., respirator use by construction workers) may reduce disease risk, although clear evidence of its benefit is lacking.1, 5Some special population groups may benefit from prophylactic use of antifungals, such as those about to undergo allogeneic solid-organ transplantation or patients with a history of active coccidioidomycosis or a positive coccidioidal serology in whom therapy with tumor necrosis factor α antagonists is being initiated. The administration of prophylactic antifungals is not recommended for HIV-1-infected patients even if they live in an endemic region.1, 5Conclusion: Now we conclude episode number 164, “More than just a headache.” Dr. Song explained that a headache with an indolent course, accompanied by subacute respiratory symptoms, nausea, vomiting, photophobia, neck stiffness, and skin lesions can be secondary to Valley Fever. The Central Valley of California, as well as other areas with dry climate, are endemic and we need to keep this disease in our differential diagnosis.This week we thank Hector Arreaza and Zheng (David) Song. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Roos KL, Tyler KL. Acute Meningitis. McGraw Hill Medical. Published 2023. Accessed August 18, 2023. https://accessmedicine.mhmedical.com/content.aspx?bookid=2129§ionid=192020493Information for Healthcare Professionals. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/health-professionals.html#printValley Fever (Coccidioidomycosis) a Training Manual for Primary Care Professionals. Accessed August 18, 2023. https://vfce.arizona.edu/sites/default/files/valleyfever_training_manual_2019_mar_final-references_different_colors.pdfAmpel NM. Coccidioidomycosis. Idsociety.org. Published July 27, 2016. Accessed August 18, 2023. https://www.idsociety.org/practice-guideline/coccidioidomycosis/Herrick KR, Trondle ME, Febles TT. Coccidioidomycosis (Valley Fever) in Primary Care. American Family Physician. 2020;101(4):221-228. Accessed August 18, 2023. https://www.aafp.org/pubs/afp/issues/2020/0215/p221.htmlValley Fever Statistics. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.htmlUpToDate. Uptodate.com. Published 2023. Accessed August 18, 2023. https://www.uptodate.com/contents/coccidioidal-meningitis?search=7%20Coccidioidal%20meningitis&source=search_result&selectedTitle=1~10&usage_type=default&display_rank=1Royalty-free music used for this episode: Tropicality by Gushito, downloaded on July 20, 2023, from  https://www.videvo.net/

A life-changing diagnostic device tested on sheep in New Zealand is about to be trialled on humans 

Normal pressure Hydrocephalus or Alzheimer's? Taking a look at NPH with Dr. Samantha Chamberlain, PT, DPT Want to make sure you stay on top of all things geriatrics? Go to https://MMOA.online to check out our Free eBooks, Lectures, & the MMOA Digest!

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Normal Pressure Hydrocephalus⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ from the Neurology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

1 John ac Alun – ymweld â Phorthdinllaen: Ar drothwy Eisteddfod Genedlaethol Llŷn ac Eifionydd eleni aeth John ac Alun am dro o gwmpas eu hoff lefydd ym Mhen Llŷn, a dewis John oedd cael mynd draw i Borthdinllaen, a rhoi gwahoddiad i Meinir Pierce Jones, un o ferched yr ardal i ddod yno am sgwrs.Arwyddocâd Significance Cysgod diogel Safe shelter Delfrydol Ideal Dyfnder Depth Porthladdoedd Ports Gofaint Blacksmith Seiri Carpenters Safle diwydiannol An industrial site Gan fwya Mostly Argian Good Lord Trochi traed Paddling2 Clip Aled Hughes:Mae hi'n anodd meddwl am Borthdinllaen fel safle diwydiannol yn tydy? Tybed faint o'r twristiaid sy'n mynd yno bob blwyddyn sy'n gwybod am hanes y lle?Ac mi arhoswn ni ym Mhen Llŷn efo'r clip nesa ‘ma. Ar Orffennaf y 26ain y llynedd, wrth edrych ‘mlaen at Eisteddfod Genedlaethol Llŷn ac Eifionydd, mi gafodd Aled Hughes gwmni'r Archdderwydd Myrddin ap Dafydd ac aeth y ddau i gopa'r Eifl, a dyma chi flas o'u sgwrs.Awgrym A suggestion Machlud Sunset Rhufeiniaid yn cilio The Romans withdrawing Anwybyddu To ignore Gwyddelod Irish people Gwaywffon Spear Penwaig Herring Dinasyddiaeth Citizenship Diwylliedig Cultured Tyndra ar y ffin Tension on the border3 Beti a'i Phobol:Dipyn bach o hanes ardal yr Eifl yn fanna gan yr Archdderwydd Myrddin ap Dafydd.Sioned Lewis oedd gwestai Beti a'i Phobol ar y 7fed o Fai 2023. Mae Sioned yn Gwnselydd ac yn Seicotherapydd ac yn dod yn wreiddiol o Ddolwyddelan yn Sir Conwy. MI fuodd hi'n gweithio mewn sawl maes gwahanol, yn gwerthu tai, yn y byd teledu a gyda Mudiad Ysgolion Meithrin. Sioned ydy Cwnselydd y rhaglen Gwesty Aduniad ar S4C. Yn y clip hwn mae hi'n sôn am ei hamser yn dioddef o gancr y fron:Archdderwydd Archdruid Cancr y fron Breast cancer Efo chdi Gyda ti Cwffio Ymladd Dychmygu Imagining Cyfres Series Triniaethau Treatments Ffydd Faith Blin Yn grac Ymdopi Coping Y blaenoriaeth The priority4 Bore Cothi:Sioned Lewis oedd honna'n siarad am ei phrofiad o fod efo cancr y fron.Ar Fedi'r 27ain y llynedd, mi roedd Max Boyce yn dathlu ei ben-blwydd yn 80, ac i nodi'r garreg filltir arbennig yma mi fuodd Max allan ar y ffordd unwaith eto yn perfformio mewn cyfres o gyngherddau. Mi gafodd Shan sgwrs efo Max cyn y daith, gan gychwyn drwy ofyn oedd y penderfyniad i deithio eto'n un anodd? Carreg filltir Milestone Yr hewl (heol) The road Rhoi'r ffidil yn y to To give up Cwpla Gorffen Ysbrydoli To inspire Clwb gwerin Folk club Uniaethu To identify Ystyried To consider5 Caryl Parry Jones: Y bytholwyrdd Max Boyce yn dathlu ei ben-blwydd drwy berfformio - wel be arall ynde? Yn ôl ym mis Mai 2023 cafodd Caryl sgwrs gyda Heather Hughes. Mae Heather yn aelod o grŵp nofio Titws Tomos Môn. Yn 2019 mi gafodd hi waedlif ar yr ymennydd a chyflwr o'r enw Hydrocephalus, sef dŵr ar yr ymennydd. Ers hynny mae hi'n nofio yn y môr ym mhob tywydd. Yn y clip hwn cawn glywed Heather yn sôn am ei phrofiad, a pha mor llesol ydy nofio yn y môr iddi hi:Bytholwyrdd Evergreen Gwaedlif ar yr ymennydd Brain haemorrhage Cyflwr Condition Llesol Beneficial Poblogrwydd Popularity Llwythi Loads Goro Gorfod6 Trystan ac Emma:Dyna enw da ar y grŵp ynde – Titws Tomos Môn!Ddechrau mis Rhagfyr mi gafodd Rhaglen Trystan ac Emma wahoddiad i Gaffi Largo ym Mhwllheli. Mi fuodd yna lawer o hwyl a sbri yn y caffi - yn siarad efo'r staff ac efo pobl leol. Un ohonyn nhw oedd Christine Jones o dre Pwllheli:Haeddu To deserve Bobol annwyl! Goodness me! Brolio To boast Yn rhagori Surpasses Nionyn picl Pickled onion7 Ffion Dafis:Christine Jones – un o gymeriadau ardal Pwllheli yn dod â llwyth o hwyl a chwerthin i Gaffi Largo'r dre.Ac yn ardal Pwllheli oedd yr Eisteddfod Genedlaethol eleni wrth gwrs ac yno cafodd fersiwn e-lyfr o'r nofel boblogaidd iawn, Un Nos Ola Leuad gan Caradog Pritchard, ei lawnsio, efo'r actorion John Ogwen a Maureen Rhys yn ei darllen. Yn y clip hwn ar raglen Ffion Dafis mae John yn sôn am y tro cynta daeth o ar draws y nofel:Digwyddiad Event Gwerthfawrogi To appreciate Beirdd Poets Lleuad Moon Gwên ryfeddol A wonderful smile Dagrau Tears Atgof Recollection

Listen as Dr. London Smith (.com) and his producer Cameron discuss Normal Pressure Hydrocephalus as they share what's coming up on their new streaming service.  Sponsored by Caldera + Lab (use code "jockdoc" to get 20% off!). Not so boring! https://calderalab.com/pages/podcast-special-offer?show=Jock+Doc&utm_medium=podcast&utm_source=JocDoc https://www.patreon.com/join/jockdocpodcast Hosts: London Smith, Cameron Clark. Produced by: Dylan Walker Created by: London Smith

 Hydrocephalus is a neurological disorder caused by an abnormal buildup of cerebrospinal fluid in the ventricles (cavities) deep within the brain. This excess fluid causes the ventricles to widen, putting harmful pressure on the brain's tissues. Its a life-threatening condition that affects more than 1 million Americans.  Anyone, at any age, can develop hydrocephalus, according to the National Institute of neurological Disorders and Stroke at the National  Institute   For TV Host Jeff Pearson “I was born in Ft. Collins, CO, in 1977. When I was 2 weeks old, it was confirmed that I had hydrocephalus and aqueductal stenosis, and I received my first shunt. Over the next few years, I had several surgeries, most related to hydrocephalus through about age 10. When I was 18, the summer after graduating from high school, I had a couple more hydrocephalus-related surgeries (one of which was a revision). Following those two surgeries, I had a nice long break for about 18 years. During that time I graduated high school, traveled the world for a year as a singer with a group called Up with People, became a productive, working adult, married Catherine, and we now have 3 amazing children (Elizabeth, Nick, and Kacia) that are growing up way too fast. Between 2013 and 2022, I had 6 more surgeries - 5 of them were directly related to hydrocephalus. Shortly after a revision in 2018, I was sitting in the exam room waiting for my neurosurgeon to come in to do a follow-up. It was quiet in the room, and I began to hear sounds from the room next to mine that sounded like distraught parents. I thought to myself, "I wonder if they are finding out that their child is going to have brain surgery..." That got me thinking and my mind was flooded with thoughts of my parents and what they may have felt after hearing that I had to have brain surgery when I was just 2 weeks old, not to mention all the revisions over the years, the worry they must have felt every time I rode my bike or skateboard somewhere, climbed...anything, or went snowboarding. I wondered if they had any support while I was growing up. Did they have anyone that they could relate to while raising a child with this condition? That gave me the beginning ideas about what would become Hydro with Hope. My wife, Catherine, and I started brainstorming how we might be able to help people. We ultimately decided to join the online community on social media (primarily Facebook and Instagram at the time), and we started our own private group. The idea behind this was to be able to reach people all around the world and let them know that, despite the scariness of brain surgery and the ensuing challenges of living with hydrocephalus, there's HOPE.” He joined me this week to tell me more.    

Title: Shunting vs. ETV/Choroid Plexus Fulguration for Hydrocephalus Guest Faculty: Michael G. DeCuypere, MD, PhD Hosts: Rushna Ali, MD and Seth F. Oliveria, MD PhD In this episode we will speak with Dr. Michael DeCuypere about the use of endoscopic techniques including endoscopic third ventriculostomy and/or choroid plexus coagulation in the management of pediatric hydrocephalus.

November 2023 Guidelines Podcast Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines. This podcast updates the 2014 guideline by affirming its recommendations as well as highlighting changes based on new literature, including recommendations on neuro-endoscopic lavage for intraventricular hemorrhage of prematurity and antibiotic impregnated shunt tubing to prevent post operative shunt infection. CNS Guidelines Podcast Host and Moderator: J. Bradley Elder, MD Author: David F. Bauer, MD, MPH Co-host: Brandon Laing, MD

Say hello to our new friend, Paisley!Paisley is a caring, silly and fierce seven-year-old from Kaukauna, WI where she lives with her parents, Ashley and Joshua, and brothers, Noah and Brooks. Paisley loves singing, dancing and being around people.Throughout the month of October, we'll be shouting love for Paisley to raise awareness for her rare medical journey with Neurocutaneous Melanocytosis with Hydrocephalus.

Meet Hailee -  a Hydrocephalus Warrior! She goes in to great detail about what life is like living with Hydrocephalus and what she is doing in her own city to spread awareness. If you are interested in following, donating or walking for Hydrocephalus, please see the information below:Website: https://www.hydroassoc.org/Information on the 2023 Hydro Walk:Sunday OCTOBER 8TH 2023 at 9:00am @ Chalco Hills Recreation AreaLink for Omaha Walk: https://secure2.convio.net/hydro/site/TR?fr_id=2047&pg=entryFacebook: @HydroAssoc

In honor of Mother's Day approaching, today's podcast is a story full of God's peace, presence, and faithfulness to the cry of a mother's heart.   Jamie Johnson, from our community group in Homewood, Alabama, shares her story of walking through the diagnosis of congenital hydrocephalus in her unborn son and how God held her head above the waters of suffering and pain. Jamie will remind you that no matter what circumstances you are walking through today, the faithfulness and goodness of God will see you through to the other side.   IN THIS EPISODE YOU WILL LEARN: * God's faithfulness is not based on your circumstances… His faithfulness it's based on Christ and the cross. * God assures us that we will have pain in this world, but He also assures us that He is with us * The frustration you have with the painful circumstances in your life does not scare God - He wants you to come to Him with your groaning.   FOR OUR PATREON INSIDERS THIS FRIDAY!   We are so excited to have Jamie featured in a “Story Within the Story” episode this month! Listen in as Amy Grote talks with Jamie more about how Prodigal Pottery got started, how Oliver is doing today, and how the past few years have shaped her faith.    Not an insider? Join us today at www.Patreon.com/STLcommunity   Support STL Ministry Order When God Shows Up - Stories of FREEDOM

Granger Smith Podcast Episode 164: It's difficult to have your child in and out of the hospital. This child in particular has had 20 different brain surgeries. The best way to deal with this struggle is to fall down at the knees of our creator. Join me as we chat about this topic and more! New podcast every Monday morning! Ask me questions! #GrangerSmithPodcast or email me at grangersmithpodcast@gmail.com