Craniosacral Therapy Use in Normal Pressure Hydrocephalus

Abstract

Nearly 700,000 adults in the US have normal pressure hydrocephalus (NPH), but it is often misdiagnosed as Alzheimer's or Parkinson's disease. In fact, a small percentage of people with the disease are properly diagnosed. NPH presents classically with a triad of symptoms: ataxic gait, dementia, and urinary incontinence. Diagnosis and treatment are provided together through a lumbar puncture. However, the only effective treatment that exists is a shunt insertion, which is a highly invasive procedure with uncertain responsiveness. As NPH is primarily diagnosed in those in advanced ages (60s and 70s), adjunctive treatment modalities should be further studied. Here we present a case of a patient diagnosed by a neurosurgeon and neurologist with NPH and a candidate for a shunt insertion whose symptoms substantially improved with one month of osteopathic manipulative treatment. Osteopathic considerations and literature are also reviewed in the broader context of craniosacral treatment.

Keywords: craniosacral therapy; csf drainage; csf shunt; cv4; hydrocephalus; lumbar puncture; normal pressure hydrocephalus; omm; osteopathic manipulative medicine; venous sinus drainage.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Park et al.

Figures

Figure 1. Normal MRI (axial T2)

Case courtesy of Associate Professor Frank Gaillard, Radiopaedia.org, rID: 37605

Figure 2. Patient MRI performed on February 4, 2020

Figure 3. Patient MRI performed on March 17, 2021

Figure 4. CSF pathway

CSF, cerebrospinal fluid

Figure 5. CV4 oblique view

Figure 6. CV4 side view

Figure 7. Venous sinus drainage at the distal superior sagittal sinus

Figure 8. Venous sinus drainage at the proximal superior sagittal sinus

Figure 9. Proposed normal pressure hydrocephalus diagnosis and treatment workflow