Hydrocephalic Parkinsonism: lessons from normal pressure hydrocephalus mimics

Journal of Clinical Movement Disorders
Brian W StarrAlberto J Espay

Abstract

Hydrocephalus is an under-recognized presentation of progressive supranuclear palsy (PSP) and dementia with Lewy bodies (DLB). We describe four normal pressure hydrocephalus (NPH)-like presentations of pathology-proven PSP (n = 3) and DLB (n = 1) and review the literature on the hydrocephalic presentation of these atypical parkinsonisms. Despite the presence of ventriculomegaly disproportionate to the extent of parenchymal atrophy, all patients demonstrated early postural impairment and/or oculomotor abnormalities that encouraged a diagnostic revision. Hallucinations were the only early atypical manifestation of the hydrocephalic DLB presentation. Early postural impairment, falls, oculomotor impairment, and/or hallucinations are inconsistent with the diagnosis of NPH and suggest PSP or DLB as the underlying NPH mimic. We postulate that previously reported cases of "dual" pathology (e.g., NPH and PSP) actually represent the hydrocephalic presentation of selected neurodegenerative disorders.

References

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Citations

Feb 23, 2018·Neurology·Charlotte SelgeKlaus Jahn
May 13, 2020·Movement Disorders : Official Journal of the Movement Disorder Society·Andrea QuattroneAldo Quattrone
May 18, 2020·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·M OharaT Yokota
Sep 23, 2020·Movement Disorders : Official Journal of the Movement Disorder Society·Alfonso FasanoJoachim K Krauss
May 4, 2018·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Alfonso Fasano, David F Tang-Wai
Aug 30, 2018·Journal of Neurology·Gilles AllaliFrederic Assal
May 1, 2021·Journal of Neurosciences in Rural Practice·Sandhya MangaloreArun Kumar Gupta

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Methods Mentioned

BETA
biopsies

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