Dear Dr. Roach: I have normal pressure hydrocephalus (NPH) and had a spinal tap a few months ago. It helped my brain fog, but my neurosurgeon didn’t want to put in a shunt. I am 96. Can repeated taps help me? — M.G.

Answer: NPH is a condition where the fluid inside the brain has a high pressure. It is unknown why this happens, but symptoms include an abnormal gait and incontinence along with the brain fog you mentioned.

When NPH is suspected, a spinal tap is a useful diagnostic test. Taking a lot of spinal fluid out, which suspends the brain and spinal cord, will temporarily lower the pressure, and if a person’s symptoms (especially their walk) get immediately better, this is a strong sign that the diagnosis is NPH.

Unfortunately the pressure builds back up within a few days, so the cure might be even worse than the disease if you needed a spinal tap every few days. There are no medications that have been proven to be effective.

This leads me to wonder why your neurosurgeon didn’t want to do the shunt, which is the definitive treatment for NPH. A shunt drains spinal fluid into the abdomen, allowing the pressure to stay low. It’s the one treatment that improves a person’s function.

While I understand that operating on the brain at age 96 has the possibility for complications, NPH tends to worsen over time. Perhaps a second opinion would be wise.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.