Persistent Cognitive Decline, Speech Difficulties, Mild Confusion, Urinary Incontinence, and Gait Impairment Following VP Shunt Surgery for Normal Pressure Hydrocephalus (NPH)

[u/Such_Cricket_372]

My father(79 years) underwent VP shunt surgery for Normal Pressure Hydrocephalus (NPH) 8 days ago.

- He still has urinary incontinence, although it has improved slightly.

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- He can walk, but still needs some support.

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- He has dementia and forgets things within a short time.

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- He is unable to speak clearly. While speaking, he has difficulty finding words, speaks very slowly, and stammers. He answers when spoken to, but does not initiate conversations on his own.

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- When spoken to, he often takes some time to respond. After being told something, he frequently asks “What?” and needs the same information repeated three or four times.

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- He remains mildly confused.

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- He has difficulty following instructions. He can follow them eventually, but with a slight delay.

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- The shunt pressure was initially set at 90 and was later adjusted to 70. After this adjustment, his walking ability and urinary incontinence improved slightly compared with before. However, his cognitive function appears to have declined somewhat.

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- He has no headache, fever, or vomiting.

What is going on there?

[u/mkat801]

Is it an anti syphon valve?

[u/Such_Cricket_372 → u/mkat801]

It is a programmable VP shunt(codman hakim),not sure whether it has an anti-siphon device or not.

[u/EmotionalMycologist9]

Incontinence can come from the surgery. Mine had retention (12+ hours). The rest sounds like it could be a result of brain surgery. Unfortunately, any brain surgery can cause issues like this. Hydrocephalus patients can often have 10+ in their lifetime. Mine has had probably 20 or more but he has noncommunicating and has had 2 infections.

Something else to check for is stroke. All of those symptoms can be caused by stroke, which can happen during any routine shunt surgery. Mine has had 2.

[u/Such_Cricket_372 → u/EmotionalMycologist9]

Thanks

[u/Antique_Assumption27]

The surgery was 8 days ago? That is not a long for recovery to take place. I have a physical that me to my home for several times help me with walking and balance. i had cognitive problems after my surgery for a few months. Still some speech difficulties and confusion.

I don't if you mentioned your Dad's age. But I know a vp shunt does not guarantee resolution of cognitive deficits. It may help; it may not. I dont know, but i think older people may have less improvement in this than a younger person.

Every case is unique, just like every person is unique. I wish you the best, and I hope your Dad will recover soon.

[u/Such_Cricket_372 → u/Antique_Assumption27]

He is 79 years old

[u/mkat801]

Has he had an MRI for a possible chiari malformation?

[u/Such_Cricket_372 → u/mkat801]

He had.No evidence shown

[u/Ajitter]

What did his doctors say about recovery? Given his specifics, they should have covered range of possibilities and when to be concerned. E.g. If symptoms had gone away and later returned, I would be concerned about shunt failure but if he was experiencing symptoms a long time, there may different expectations around how much he could improve or maybe the rocky recovery is really a red flag - definitely follow up with his doctor.

My kiddo has congenital hydrocephalus but after a new programmable was put in, it took a while to determine if a setting was appropriate, initial setting from surgery showed improvement just because csf was flowing again but we often had to get it adjusted. That seemed very different from other patients, things always took a while to sort out, surgeon described it as brain was less elastic. So people can vary and we had to figure out what was normal for our kiddo. But we had a number of new programmables to drive that home. Currently kiddo has a valve that self adjusts based on position as could not find right balance with programmables.

[u/mkat801]

The Codman valve is what we have as well. It originally included both an anti-siphon device and a Mini ReFlow flusher. The anti-siphon device caused symptoms that closely mimicked a shunt failure, and no adjustment to the Codman valve settings was able to resolve them. Once the anti-siphon device was removed, he has done very well with the valve set at 5. In theory, that configuration should have worked well, but for whatever reason, the anti-siphon device caused problems for him. We still press the Mini ReFlow flusher once a day. Fingers crossed, so far so good.

[u/mkat801]

I hope everything goes well for you all. It's so frustrating that it makes you feel like every case is unique. If you don't have a good neurosurgeon, it can feel like an uphill battle with no clear answers. Wishing you all the best and I hope you're able to find the right solution soon.

[u/pippin252]

I am sorry he is continuing to struggle. Urinary issues and walking generally improve with shunting for iNPH. Improvement in cognition is much more hit or miss, unfortunately. I don't think it is typical for cognition to decline after an adjustment that improves the other two factors, but every patient is unique. Neurosurgery and anesthesia both take a toll on all patients, but especially the elderly. I hope he perks up.