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Wet, Wacky, Wobbly – NPH and Florida Medical Malpractice

Posted by Guy DiMartino | Dec 18, 2012 | 0 Comments

Florida medical malpractice and personal injury lawyer, Guy S.  DiMartino, DC, JD, discusses the clinical and legal implications of normal pressure hydrocephalus.

Medicine is all about triads.  A triad is a clinical presentation with three associated signs or symptoms.  There is a classic triad of signs and symptoms associated with normal pressure hydrocephalus that I learned to remember as wet, wacky, wobbly and when a patient presented with these issues normal pressure hydrocephalus needed to be ruled out.

What is this Normal Pressure Hydrocephalus?

Normal pressure hydrocephalus is a brain problem that impacts the central nervous system.  In order to understand how it develops, you may need a brief overview of the brain.  The brain sits suspended within the skull and it is bathed in cerebral spinal fluid (CSF).  The brain has its own plumbing system called ventricles and cisterns. CSF will travel through this plumbing system.  When the plumbing system gets blocked, CSF will build up in the skull and put pressure on the brain causing normal pressure hydrocephalus.

Why Wet, Wacky, and Wobbly?

As the pressure develops in the head, parts of the brain are compressed and the patient will develop:

  • Urinary incontinence – the wet
  • Dementia – the wacky
  • Ataxia – difficulty walking – the wobbly
  • The Difficulty in Dealing with Normal Pressure Hydrocephalus

Normal pressure hydrocephalus can be difficult to diagnose and requires the doctor, physician's assistant or nurse to actually listen to the patient or the patient's family.  NPH is different from other types of hydrocephalus (such as traumatic) because it takes a period of time to develop. The patient's onset of symptoms with NPH is often gradual.  And as said above the classic triad of urinary problems, dementia, and changes in gait are common with aging.  If the doctor doesn't consider NPH in his differential diagnosis, the appropriate tests will not be performed and the condition will be missed until it's too late.

Diagnosis of NPH

Sometimes this condition will be noticed on CT or MRI of the brain.  The radiologist can visualize a problem within the plumbing system or a change in brain tissue because of pressure.  The test of choice is a spinal tap.  After the spinal tap, the patient will usually report a change in one or more symptoms because some of the pressure was relieved.


The goal of treatment is patient with normal pressure hydrocephalus is to decrease the amount of CSF in the brain, thereby decreasing the pressure on the brain.  Neurosurgeons can use different types of shunts to assist the plumbing system in moving the CSF.  If the condition is caught and treated before permanent damage to the brain tissue occurs, the patients symptoms will improve.

Medical Malpractice

The standard of care in medicine requires doctors to follow certain algorithms when working up a patient.  When an older patient presents with dementia, urinary incontinence and ataxia, the doctor has to rule out normal pressure hydrocephalus.  If the doctor does not rule out the condition, and the patient suffers permanent brain damage, there may be a medical malpractice case.

If you have any questions about a potential brain injury medical malpractice case, contact Florida medical malpractice lawyer, Guy S. DiMartino, DC, JD. at (352) 267-9168 or fill out the Internet consultation form on the right. Bridging Law & Medicine!

About the Author

Guy DiMartino

I have loved helping people in need for almost three decades.  It has been my privilege to serve people as their pastor, chiropractor, and lawyer.  The current focus of my legal practice and lifes passion is helping the seriously injured receive complete compensation for their injuries. I am a ...


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