When our otherwise healthy 80-year-old mother mentioned she was having trouble with balance in early 2014, my siblings and I didn't think much of it. We are a family of physicians and hypochondriacs, so obsessing over every possible medical ailment was the norm.
Two years after my dad's death in 2012, my mother invited me on a Caribbean cruise. When I met her at the airport, I was surprised to see her using a cane. "It helps with my balance," she said. I also noticed a distinct shuffle in her gait, which I attributed to her age.
It wasn't until we went for a swim in the Caribbean that I felt something might be wrong. Wading into the water, Mom went down when a wave unleveled the sand beneath her feet and she was unable to get up. It took two men to lift her. There was no muscle power; it was as though she were glued to the ground.
Back in Florida (our mother divides her time between Florida and New York City), I insisted on an appointment with her general practitioner, who referred her to a rheumatologist for the muscle weakness. Tests ruled out nerve damage and autoimmune diseases. She was prescribed 12 weeks of physical therapy, after which she was no better.
Over the next year, Mom's overall health declined steeply; her gait became wildly inconsistent, she had severe incontinence, and her always sharp memory began to fail. She didn't want to leave the house, even to shop for food, for fear she would fall. My mother was referred to a neurologist in Florida, who conducted an assessment and ruled out both Parkinson's and Alzheimer's diseases. He told us to continue to watch our mother and that he might follow up with more tests later. We were stumped.
On Thanksgiving morning 2015, we received a call from a family friend that our mother had fallen out of bed. Unable to move, she was taken by ambulance to the hospital. My sister and I flew to Florida later that day and decided our mother could no longer live on her own.
Once back in New York City, Mom began using a walker full-time and was effectively homebound. She finally agreed, in July 2016, that assisted living was the only answer, and we prepared to sell her New York condo.
An annual checkup a month later changed everything. Her longtime internist in New York questioned Mom's profound and rapid decline and suspected normal pressure hydrocephalus, a condition that occurs when the flow of cerebrospinal fluid in ventricles in the brain is blocked, causing the ventricles to enlarge. This causes nerve pathways to stretch and can create the symptoms Mom was experiencing—incontinence, trouble walking, and poor memory.
Her internist referred her to a neurologist for an MRI, which indeed showed fluid. For a definitive diagnosis, the neurologist performed a lumbar puncture to drain some fluid from her brain. Within an hour of the procedure, Mom got off the table and walked across the floor—sans shuffle.
The neurologist scheduled surgery for the following week to place a shunt at the base of Mom's brain to divert the excess cerebrospinal fluid to another part of the body where it is reabsorbed. After three days in the hospital and three weeks in a rehab facility, our mother was a different person. Her walking improved dramatically, she was no longer incontinent, and her memory and wit returned.
She continued to improve and is now back to living the life she enjoyed prior to the onset of her normal pressure hydrocephalus symptoms. Regular neurologic checkups include shunt adjustments, using a magnet placed at the base of her neck.
My siblings and I are eternally grateful to our mother's internist. If he hadn't recognized the signs, we might never have gotten our mother back. Now we tell anyone who will listen: Familiarize yourself with the symptoms of normal pressure hydrocephalus and consider suggesting it if symptoms don't make sense or add up.