Title : A case of normal pressure hydrocephalus in an elderly male
Abstract:
Normal pressure hydrocephalus is a rare neurologic disorder primarily impacting older adults, classically presenting with clinical triad of gait dysfunction, cognitive impairment, and urinary incontinence, in addition to hydrocephalus on brain imaging. Normal pressure hydrocephalus is a relatively rare condition.
We present a case of idiopathic normal pressure hydrocephalus in a 74-year-old male with past medical history of atrial fibrillation, hypertension, type II diabetes, chronic neutropenia, and recurrent urinary tract infections who presented to the emergency department with primary concerns of cough, shortness of breath, and cognitive impairment. Through further assessment, this patient was discovered to have the full clinical triad of normal pressure hydrocephalus including gait dysfunction, cognitive impairment, and urinary incontinence. A head computerized tomography noted prominence of the ventricular system out of proportion to the subarachnoid spaces with no obstructing masses.
Lumbar puncture was performed, removing 30 mL of cerebrospinal fluid (CSF), at a normal opening pressure (13 cm H2O), with elevated protein and glucose, which is likely secondary to a traumatic lumbar tap. Based off clinical presentation, imaging, and lumbar puncture results, the diagnosis of normal pressure hydrocephalus was made. Due to the patient’s severe cognitive impairment and unclear symptom benefit in response to lumbar puncture, shunt surgery was not performed, and rather the emphasis was on symptomatic improvement.
Audience Take Away Notes:
- Differential Diagnosis Challenges in Neurological Cases
- Role of Lumbar Puncture in NPH Diagnosis
- Considerations for shunt surgery in NPH patients
- Interdisciplinary approach to NPH management
