J Neurol Surg A Cent Eur Neurosurg 2019; 80(05): 404-408
DOI: 10.1055/s-0039-1685185
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Normal Pressure Hydrocephalus with Primary Presentation of Psychiatric Disturbance: Case Report

Michael Kogan
1   Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, United States
2   Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, United States
,
Justice Agyei
1   Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, United States
2   Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, United States
,
Kevin J. Cuddahee
2   Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, United States
,
Kevin J. Gibbons
1   Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, United States
2   Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, United States
› Author Affiliations
Further Information

Publication History

29 June 2018

17 October 2018

Publication Date:
10 May 2019 (online)

Abstract

Background and Objective Progressive impairment of cognitive function is a common feature seen in patients with normal pressure hydrocephalus (NPH). Along with cognitive decline, many of the other classic symptoms of NPH are chronic and rarely present with overwhelming anxiety. We report the case of a 63-year-old man who presented with recent primary psychiatric manifestation of severe disabling anxiety and otherwise a minimal change in gait and no urinary disturbance.

Clinical Presentation The patient's work-up consisted of magnetic resonance imaging that showed moderate ventriculomegaly but no findings concerning for acute obstructive hydrocephalus. A single-photon emission computed tomography scan was markedly abnormal with severe hypoperfusion consistent with hydrocephalus. Initially shunting was not advised but was eventually performed after a dramatic response to a large-volume lumbar puncture. After considerable discussion, he underwent elective ventriculoperitoneal shunt placement and had dramatic and sustained improvement in his anxiety.

Conclusion We believe this case report is a unique description of NPH symptomology and might guide future research or clinical decision making.

Author Contributions

Conception and design: Gibbons; Data acquisition: all authors; Data analysis and interpretation: all authors; Drafting the manuscript: Agyei, Kogan; Critically revising the manuscript: all authors; Final approval of the manuscript: all authors.


 
  • References

  • 1 Gooriah R, Raman A. Idiopathic normal pressure hydrocephalus: an overview of pathophysiology, clinical features, diagnosis and treatment In: Moretti DV, ed. Update on Dementia. Available at: https://www.intechopen.com/books/update-on-dementia/idiopathic-normal-pressure-hydrocephalus-an-overview-of-pathophysiology-clinical-features-diagnosis-
  • 2 Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965; 2 (04) 307-327
  • 3 Nassar BR, Lippa CF. Idiopathic normal pressure hydrocephalus: a review for general practitioners. Gerontol Geriatr Med 2016; 2: 2333721416643702
  • 4 Kito Y, Kazui H, Kubo Y. , et al. Neuropsychiatric symptoms in patients with idiopathic normal pressure hydrocephalus. Behav Neurol 2009; 21 (03) 165-174
  • 5 Hashimoto M, Ishikawa M, Mori E, Kuwana N. ; Study of INPH on neurological improvement (SINPHONI) Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res 2010; 7: 18
  • 6 Hiraoka K, Meguro K, Mori E. Prevalence of idiopathic normal-pressure hydrocephalus in the elderly population of a Japanese rural community. Neurol Med Chir (Tokyo) 2008; 48 (05) 197-199 ; discussion 199–200
  • 7 Iseki C, Kawanami T, Nagasawa H. , et al. Asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on MRI (AVIM) in the elderly: a prospective study in a Japanese population. J Neurol Sci 2009; 277 (1–2): 54-57
  • 8 Saito M, Nishio Y, Kanno S. , et al. Cognitive profile of idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord Extra 2011; 1 (01) 202-211
  • 9 Missotten P, Squelard G, Ylieff M. , et al. Relationship between quality of life and cognitive decline in dementia. Dement Geriatr Cogn Disord 2008; 25 (06) 564-572
  • 10 Banerjee S, Smith SC, Lamping DL. , et al. Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia. J Neurol Neurosurg Psychiatry 2006; 77 (02) 146-148
  • 11 Lindqvist G, Andersson H, Bilting M, Blomstrand C, Malmgren H, Wikkelsø C. Normal pressure hydrocephalus: psychiatric findings before and after shunt operation classified in a new diagnostic system for organic psychiatry. Acta Psychiatr Scand Suppl 1993; 373: 18-32
  • 12 Kazui H, Miyajima M, Mori E, Ishikawa M. ; SINPHONI-2 Investigators. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. Lancet Neurol 2015; 14 (06) 585-594
  • 13 Larsson A, Wikkelsö C, Bilting M, Stephensen H. Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 1991; 84 (06) 475-482
  • 14 Poca MA, Solana E, Martínez-Ricarte FR, Romero M, Gándara D, Sahuquillo J. Idiopathic normal pressure hydrocephalus: results of a prospective cohort of 236 shunted patients. Acta Neurochir Suppl (Wien) 2012; 114: 247-253
  • 15 Klinge P, Hellström P, Tans J, Wikkelsø C. ; European iNPH Multicentre Study Group. One-year outcome in the European multicentre study on iNPH. Acta Neurol Scand 2012; 126 (03) 145-153