There are only two effective methods of treatment. Injection of alcohol into the involved divi- sion oi the nerve gives relief for a period that averages from twelve to eighteen months. The affected area increases with succeeding attacks, the attacks last longer and the free intervals get shorter, it becomes increasingly diﬂicult to inject the nerves because of formation of scar tissue, and eventually all patients come to operation.
Division of the sensory root proximal to the Gasserian ganglion gives permanent relief from the pain. The dangers of this procedure are frequently put to the incapacitated suﬂerer on the basis of the high mortality of the early days of the operation. Many surgeons now have large series of cases with a mortality of less than 5 per cent. Considering the advanced age of most of these patients, such a mortality is low for an operation which assures freedom from unbearable pain 1).
Hickman et al. reviewed the medical records of 529 patients who underwent shunt placement for idiopathic normal pressure hydrocephalus (iNPH) at their institution between July 2001 and March 2015. Variables associated with shunt-responsive iNPH were identified using bivariate and multivariate analyses. Detailed alcohol consumption information was obtained for 328 patients and was used to examine the relationship between alcohol and shunt-responsive iNPH. A computerized patient registry from 2 academic medical centers was queried to determine the prevalence of alcohol abuse among 1665 iNPH patients.
Bivariate analysis identified associations between shunt-responsive iNPH and gait difficulty (OR 4.59, 95% CI 2.32-9.09; p < 0.0001), dementia (OR 1.79, 95% CI 1.14-2.80; p = 0.01), incontinence (OR 1.77, 95% CI 1.13-2.76; p = 0.01), and alcohol use (OR 1.98, 95% CI 1.23-3.16; p = 0.03). Borderline significance was observed for hyperlipidemia (OR 1.56, 95% CI 0.99-2.45; p = 0.054), a family history of hyperlipidemia (OR 3.09, 95% CI 0.93-10.26, p = 0.054), and diabetes (OR 1.83, 95% CI 0.96-3.51; p = 0.064). Multivariate analysis identified associations with gait difficulty (OR 3.98, 95% CI 1.81-8.77; p = 0.0006) and alcohol (OR 1.94, 95% CI 1.10-3.39; p = 0.04). Increased alcohol intake correlated with greater improvement after CSF drainage. Alcohol abuse was 2.5 times more prevalent among iNPH patients than matched controls.
Alcohol consumption is associated with the development of shunt-responsive iNPH 2).