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

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.

Keywords

anxiety - normal pressure hydrocephalus - psychiatric - ventriculoperitoneal shunt

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.

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