scholarly journals Comorbid Normal Pressure Hydrocephalus with Parkinsonism: A Clinical Challenge and Call for Awareness

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
A. Cucca ◽  
M. C. Biagioni ◽  
K. Sharma ◽  
J. Golomb ◽  
R. M. Gilbert ◽  
...  
Keyword(s):  
Clinical Features ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Postural Instability ◽  
Concomitant Disease ◽  
Clinical Challenge ◽  
Neurologic Disorders ◽  
Insidious Onset ◽  
Gait Dysfunction

Idiopathic normal pressure hydrocephalus (iNPH) is the most common cause of hydrocephalus in adults. The diagnosis may be challenging, requiring collaborative efforts between different specialists. According to the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders, iNPH should be considered in the differential of any unexplained gait failure with insidious onset. Recognizing iNPH can be even more difficult in the presence of comorbid neurologic disorders. Among these, idiopathic Parkinson’s disease (PD) is one of the major neurologic causes of gait dysfunction in the elderly. Both conditions have their peak prevalence between the 6th and the 7th decade. Importantly, postural instability and gait dysfunction are core clinical features in both iNPH and PD. Therefore, diagnosing iNPH where diagnostic criteria of PD have been met represents an additional clinical challenge. Here, we report a patient with parkinsonism initially consistent with PD who subsequently displayed rapidly progressive postural instability and gait dysfunction leading to the diagnosis of concomitant iNPH. In the following sections, we will review the clinical features of iNPH, as well as the overlapping and discriminating features when degenerative parkinsonism is in the differential diagnosis. Understanding and recognizing the potential for concomitant disease are critical when treating both conditions.

scholarly journals Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

2021 ◽  
pp. 434-440
Author(s):  
Micaela Owens ◽  
Na Tosha Gatson ◽  
Gino Mongelluzzo ◽  
Oded Goren ◽  
Eric Newman ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Normal Pressure Hydrocephalus ◽  
Immune Suppression ◽  
Normal Pressure ◽  
The Elderly ◽  
Common Cause ◽  
Gait Abnormality ◽  
Ventriculoperitoneal Shunting ◽  
Patient Reported ◽  
Rheumatoid Meningitis

Normal-pressure hydrocephalus (NPH) is a common cause of gait apraxia, cognitive impairment, and urinary incontinence in the elderly. It is usually a primary idiopathic disorder but can be secondary. We present a case of secondary NPH due to biopsy-confirmed rheumatoid meningitis initially refractory to intravenous (IV) immunotherapy. Our patient reported an excellent response right after shunting. Her gait remains normal one and a half years later. We searched PubMed for similar cases of rheumatoid meningitis with gait abnormality for additional clinicopathologic discussion. The patient’s movement disorder initially improved with steroid taper. However, she developed progressive symptoms, later on, refractory to IV solumedrol and rituximab. She underwent ventriculoperitoneal shunting (VPS) and reported an outstanding outcome. This is the first reported biopsy-confirmed case of rheumatoid meningitis causing NPH to undergo shunting for immediate improvement. Previous cases of rheumatoid meningitis-associated Parkinsonism have improved with steroid induction. Although our patient’s rheumatoid arthritis is now controlled, her case illustrates that NPH in autoinflammatory conditions may not recover with immune suppression alone. VPS is an option for a faster response in secondary NPH due to rheumatoid meningitis or other inflammatory disorders with progressive symptoms despite standard induction therapy.

scholarly journals Progression in Neuroimaging of Normal Pressure Hydrocephalus

2021 ◽  
Vol 12 ◽  
Author(s):  
Rui Yin ◽  
Junxian Wen ◽  
Junji Wei
Keyword(s):  
Future Development ◽  
Normal Pressure Hydrocephalus ◽  
Large Scale ◽  
Elderly Population ◽  
Normal Pressure ◽  
The Elderly ◽  
Rapid Identification ◽  
Clinical Syndrome ◽  
Surgical Interventions ◽  
Large Scale Screening

Normal-pressure hydrocephalus is a clinical syndrome that mainly targets the elderly population. It features dementia, impaired walking, and the malfunction of sphincters. The rapid identification and large-scale screening of patients with normal-pressure hydrocephalus (NPH) are of great significance as surgical interventions can greatly improve or even reverse the symptoms. This review aims to summarize the traditional parameters used to diagnose NPH and the emerging progression in neuroimaging of the disease, hoping to provide an up-to-date overall perspective and summarize the possible direction of its future development.

scholarly journals Progressive supranuclear palsy in a sample of brazilian population: clinical features of 16 patients

2002 ◽  
Vol 60 (4) ◽  
pp. 917-922 ◽  
Author(s):  
Paulo Eduardo Mestrinelli Carrilho ◽  
Egberto Reis Barbosa
Keyword(s):  
Progressive Supranuclear Palsy ◽  
Clinical Features ◽  
Age Of Onset ◽  
Disease Onset ◽  
Final Diagnosis ◽  
Postural Instability ◽  
Chronic Dacryocystitis ◽  
Neurologic Disorders ◽  
The Mean ◽  
Vertical Gaze

Progressive supranuclear palsy (PSP) is an uncommon disorder characterized by marked postural instability, vertical gaze abnormalities and axial rigidity. The purpose of this study is to report the clinical features of 16 consecutive subjects seen over a 10-year period at a Movement Disorders Clinic. These subjects fulfilled criteria for probable PSP namely those of the National Institute of Neurologic Disorders and Stroke (NINDS) and the Society for PSP (SPSP). This patient-group represented 2.1% of all degenerative parkinsonians observed and the mean age of onset of the disease was 64.7 years (sd = ± 7.2). Postural instability with falls was the most frequent initial feature presented in PSP patients (62.5%). The hallmark of the disease, the supranuclear vertical gaze palsy, appeared after 2.3 years of disease onset, and only 12.5% had such manifestation at the first evaluation. Transient tremor was observed with a relatively high frequency in this group (44%), but only 19% had rest tremor. Chronic dacryocystitis, probably related to a paucity of blinking, was observed in two patients as an inaugural manifestation. In the first evaluation, only 19% of the 16 patients were diagnosed as probable PSP. The mean interval prior to the final diagnosis was 2.4 years.

scholarly journals Normal-pressure hydrocephalus: A critical review

2019 ◽  
Vol 13 (2) ◽  
pp. 133-143 ◽  
Author(s):  
Louise Makarem Oliveira ◽  
Ricardo Nitrini ◽  
Gustavo C. Román
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Critical Review ◽  
Normal Pressure ◽  
The Elderly ◽  
Expert Assessment ◽  
Imaging Features ◽  
Diagnostic Challenge ◽  
Urinary Infections ◽  
Obstructive Sleep ◽  
Surgical Treatments

ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords “normal-pressure hydrocephalus” / “idiopathic normal-pressure hydrocephalus” / “secondary normal-pressure hydrocephalus” / “NPH” / “ventriculoperitoneal shunt”. The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

Flow Void of Cerebrospinal Fluid in Idiopathic Normal Pressure Hydrocephalus of the Elderly: Can It Predict Outcome after Shunting?

Neurosurgery ◽  
1997 ◽  
Vol 40 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Joachim K. Krauss ◽  
Jens P. Regel ◽  
Werner Vach ◽  
Freimut D. J??ngling ◽  
Dirk W. Droste ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Flow Void

scholarly journals Idiopathic normal pressure hydrocephalus presenting with paroxysmal paraparesis as a cardinal symptom: A case presentation

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Andreas Eleftheriou ◽  
◽  
Christina Koumantzia ◽  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Elderly Population ◽  
Progressive Disease ◽  
Clinical History ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Case Presentation ◽  
Physical Findings ◽  
Cardinal Symptom

Idiopathic normal pressure hydrocephalus (iNPH) is a gradually progressive disease affecting the elderly population. The diagnosis of probable iNPH is based on clinical history, physical findings, brain imaging. INPH involves non-obstructive enlargement of the cerebral ventricles combined with one or more symptoms of cognitive decline, impaired gait and balance, and urinary urgency. Our case describes an unusual coexistence of radiological and clinical iNPH symptoms with paroxysmal paraparesis.

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