PMID: 9188018Apr 1, 1997Paper

Normal-pressure hydrocephalus with misleading features of irreversible dementias: a case report

Journal of Geriatric Psychiatry and Neurology
M SchwarzschildJ D Schmahmann

Abstract

An 85-year-old man presented with the clinical triad (gait instability, dementia, and bladder and bowel incontinence), the ventriculomegaly, and the normal CSF pressure that characterize normal-pressure hydrocephalus (NPH). Diagnostic uncertainty was raised by an unusually rapid onset and a lack of initial response to CSF tap tests. Additionally, periodic sharp waves on EEG suggested the possibility of Creutzfeldt-Jakob disease, and positron emission tomography (PET) demonstrated a pattern of cerebral hypometabolism typical of Alzheimer's disease. Nevertheless, the diagnosis of NPH was supported by delayed improvement following CSF tap tests, and it was confirmed by a dramatic clinical recovery after CSF shunting, resolution of the EEG and PET abnormalities, and a normal brain biopsy. NPH remains one of the few reversible causes of dementia, and the presence of its core features, regardless of rate of onset or ancillary test results, warrants careful consideration of therapeutic intervention.

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Citations

Nov 8, 2008·Annals of the New York Academy of Sciences·Jeremy D SchmahmannChristopher M Filley
May 25, 2007·IEEE Transactions on Information Technology in Biomedicine : a Publication of the IEEE Engineering in Medicine and Biology Society·Yu-Ping WangChi-Ming Huang
Oct 7, 2015·Frontiers in Psychology·Constantina Theofanopoulou
Oct 29, 2004·The New England Journal of Medicine·Jack de la TorreGeorge Perry
Jun 27, 2007·The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses·John J Fraser, Cira Fraser

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