Never Seen It Before

Come to think of it, most of my blogs could have the above title--anyway, we admitted a patient from the jungle to the hospital the other day with a strange story.  Her name was Mrs. L.  She had developed shingles around her eye, and around the same time had developed increased confusion and difficulty walking.  Upon presentation, she knew her own name but didn't know where she was.  When asked if she knew the name of the lady with her (her sister), she named a fish.  Just having shingles around the eye can be an important problem for sure, and it can be vision-threatening.  Fortunately the eye situation seemed to be under control, but we couldn't figure out what was going on with her other symptoms.  Mrs. L had some resources and was able to get a CAT scan of her head, which revealed that her brain was small in size.  This finding is definitely not normal for a lady in her early 40's.  On further questioning, we learned that Mrs. L had actually been pretty confused for several months now, often losing her way in the jungle or forgetting what she set out to do--for example, going to get a machete and bringing back a banana.  We decided to withdraw a significant amount of spinal fluid from Mrs. L, and we found that she probably didn't have an infection around her brain (therefore there was probably no link between the shingles and the confusion).  However, just pulling out the spinal fluid seemed to make many things better for her within a few hours.  Now Mrs. L recognizes her sister, walks almost normally, and knows that she is in the hospital.  She appears to be suffering from a condition known as normal pressure hydrocephalus (NPH).  I've never seen a patient with this problem before.  In NPH, the increased fluid makes it difficult for the brain to function normally.  This is normally treated by surgically placing a tube that leads from the brain into the abdominal cavity (a ventriculoperitoneal shunt), and many times the symptoms are greatly improved with treatment.  Mrs. L has been sent to Quito for consideration for placement of the shunt.  Please be praying that it will go well for this young lady.