Los Angeles (California, US): According to a new study, some patients with behavioural-variant Frontotemporal Dementia (bvFTD), an incurable condition that makes patients lose their ability to control their behaviour and cope with daily living, researchers found that patients may instead have a cerebrospinal fluid leak, which is often treatable. The findings of the study published in the peer-reviewed journal Alzheimer's & Dementia: Translational Research and Clinical Interventions, may point the way to a cure.
"Many of these patients experience cognitive, behavioral and personality changes so severe that they are arrested or placed in nursing homes," said Wouter Schievink, MD, director of the Cerebrospinal Fluid Leak and Microvascular Neurosurgery Program and professor of Neurosurgery at Cedars-Sinai. "If they have behavioral-variant frontotemporal dementia with an unknown cause, then no treatment is available. But our study shows that patients with cerebrospinal fluid leaks can be cured if we can find the source of the leak."
Cerebrospinal Fluid (CSF) circulates in and around the brain and spinal cord to help cushion them from injury. When this fluid leaks into the body, the brain can sag, causing dementia symptoms. Schievink said many patients with brain sagging-which can be detected through MRI-go undiagnosed, and he advises clinicians to take a second look at patients with telltale symptoms. "A knowledgeable radiologist, neurosurgeon or neurologist should check the patient's MRI again to make sure there is no evidence for brain sagging," Schievink said.
Clinicians can also ask about a history of severe headaches that improve when the patient lies down, significant sleepiness even after adequate nighttime sleep, and whether the patient has ever been diagnosed with a Chiari brain malformation, a condition in which brain tissue extends into the spinal canal. Brain sagging, Schievink said, is often mistaken for a Chiari malformation. Even when brain sagging is detected, the source of a CSF leak can be difficult to locate. When the fluid leaks through a tear or cyst in the surrounding membrane, it is visible on CT myelogram imaging with the aid of contrast medium.