Becker’s Healthcare Podcast Summary

Episode: Dr. Matthew Potts, Neurosurgeon at Northwestern Medicine
Release Date: June 21, 2025

Introduction

In this episode of the Becker’s Healthcare Podcast, host Laura Dearda engages in an insightful conversation with Dr. Matthew Potts, a neurosurgeon specializing in vascular neurosurgery at Northwestern Medicine. The discussion centers around normal pressure hydrocephalus (NPH), highlighted by the recent diagnosis of the renowned musician Billy Joel. Dr. Potts delves into the symptoms, diagnosis, treatment options, and the importance of awareness among patients and clinicians.

Dr. Potts’ Background

Dr. Potts provides an overview of his professional journey, emphasizing his primary focus on vascular neurosurgery and his growing interest in hydrocephalus, particularly NPH.
“I am a neurosurgeon at Northwestern. My primary clinical focus is vascular neurosurgery. But over the years, I've taken on an interest in hydrocephalus and normal pressure hydrocephalus in particular.” [00:50]

Understanding Normal Pressure Hydrocephalus

Symptoms and Warning Signs
Dr. Potts outlines the classic triad of NPH symptoms:

1. Gait Abnormalities
2. Cognitive Dysfunction
3. Urinary Incontinence

“The classic symptoms that, you know, we learn about in school? It's a triad of three symptoms, obviously, since it's triad of gait abnormalities, cognitive dysfunction, and urinary incontinence.” [01:16]

He emphasizes that these symptoms are often prevalent in older adults and can be mistaken for other conditions, making accurate diagnosis crucial.

Communicating with Patients

Engaging and Educating Patients
Dr. Potts discusses the challenges in communicating with patients who may attribute their symptoms to common age-related issues rather than NPH. He highlights the importance of thorough evaluation to differentiate NPH from other potential causes.

“The challenge with this population is that those symptoms... are very common in older patients. And it's the older patients where we primarily see idiopathic normal pressure hydrocephalus.” [02:02]

Diagnosis Process

Diagnosing NPH
Accurate diagnosis involves a meticulous process to confirm NPH and rule out other conditions:

1. Initial Assessment: Reviewing patient history and symptoms.
2. Imaging Studies:
   • CT Scan: Identifies enlarged ventricles.
   • MRI: Provides detailed imaging to assess ventricle size and brain structure.

“The bare minimum workup is some imaging of the brain, CT scan can show you that the ventricles are enlarged... an MRI, because not only does it show you that the ventricles are enlarged, but it looks at the brain in other ways and can help kind of narrow the diagnosis.” [09:22]

3. CSF Drainage Tests:
   • High Volume Lumbar Puncture: Removal of 30 to 50 cc of cerebrospinal fluid (CSF) to observe symptom improvement.
     “We do a lumbar puncture, we remove 30 to 50 cc of cerebral spinal fluid... do they get better?” [04:12]
   • Lumbar Drain Trial: Continuous CSF drainage over several days with repeated gait and cognitive assessments.
     “We actually bring them into the hospital... repeat those gait and balance tests.” [04:12]

Treatment Options

Shunt Surgery
The primary treatment for NPH is the implantation of a shunt, a device that diverts excess CSF from the brain to another part of the body, thereby reducing pressure and alleviating symptoms.

“Ultimately, the treatment that we have for normal pressure hydrocephalus is what we call a shunt... to remove some of that fluid, relieve a little bit of the pressure.” [03:31]

Recovery and Prognosis

Potential for Recovery
Dr. Potts explains that recovery outcomes vary based on symptom severity and duration. Early intervention typically results in significant improvement, especially in gait abnormalities. Cognitive and urinary symptoms may also improve but are more variable.

“If you catch somebody very early on... I think their chances of having significant improvement are very high.” [04:22]

He also notes that even if initial CSF drainage tests don’t show improvement, some patients may still benefit from shunt surgery based on further studies.

“There have been studies where they ultimately shunted everybody... some patients who actually will improve with a shunt, even if they didn't improve initially with our test of CSF drainage.” [09:22]

Importance of Awareness

Raising Awareness Among Patients and Clinicians
Dr. Potts underscores the critical need for increased awareness of NPH among both patients and healthcare providers. Misdiagnosis can lead to missed opportunities for effective treatment, especially since NPH is a treatable form of dementia.

“The biggest message and the biggest impact... is awareness and that patients, primary care providers, general neurologists, are going to become more aware of this.” [09:45]

He advocates for comprehensive initial workups and heightened vigilance in recognizing NPH symptoms to ensure timely referral and treatment.

Conclusion

The podcast concludes with Dr. Potts expressing optimism about the advancements in diagnosing and treating NPH. He reiterates the significance of early detection and proper management in improving patients' quality of life.

“We have a great treatment. So once somebody lands in a neurosurgeon's office, I think if they have normal pressure hydrocephalus, that's going to get diagnosed and they're going to get the treatment they need.” [09:45]

Key Takeaways

• NPH Symptoms: Gait abnormalities, cognitive dysfunction, urinary incontinence.
• Diagnosis: Comprehensive evaluation including imaging and CSF drainage tests.
• Treatment: Shunt surgery is the primary option with potential for significant recovery.
• Awareness: Critical for both patients and healthcare providers to ensure timely and accurate diagnosis.

Notable Quotes

• “The classic symptoms... is a triad of three symptoms, obviously, since it's triad of gait abnormalities, cognitive dysfunction, and urinary incontinence.” — Dr. Matthew Potts [01:16]
• “It’s easy for somebody to just be given a diagnosis of dementia or Alzheimer's... normal pressure hydrocephalus, that is actually a treatable form of dementia.” — Dr. Matthew Potts [09:45]

Final Thoughts

Dr. Potts emphasizes the transformative impact that proper diagnosis and treatment of NPH can have on individuals, potentially reversing debilitating symptoms and restoring quality of life. The episode serves as an essential resource for understanding NPH and highlights the importance of continued education and awareness in the medical community.