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A dementia story with a happier ending
International Journal of Psychiatry in Clinical Practice
|June 20, 2014
Summary
A patient with Parkinson's disease symptoms and personality changes was diagnosed with normal pressure hydrocephalus (NPH). A ventriculo-peritoneal shunt (VPS) insertion resolved most physical and mental health issues, highlighting NPH as a treatable cause.
Area of Science:
- Neurology
- Neurosurgery
- Geriatrics
Background:
- Parkinson's disease is a progressive neurodegenerative disorder.
- Normal pressure hydrocephalus (NPH) can present with gait disturbance, urinary incontinence, and cognitive decline.
- Misdiagnosis of NPH can lead to ineffective treatments and delayed management.
Purpose of the Study:
- To report a case of misdiagnosed Parkinson's disease.
- To highlight the importance of considering NPH in elderly patients with parkinsonism and behavioral changes.
- To demonstrate the efficacy of ventriculo-peritoneal shunt (VPS) in treating NPH.
Main Methods:
- A 77-year-old female patient initially diagnosed with Parkinson's disease was treated with antiparkinsonian drugs.
- The patient exhibited aggressive outbursts and personality changes, prompting psychiatric referral.
- Diagnostic investigations revealed normal pressure hydrocephalus (NPH), leading to ventriculo-peritoneal shunt (VPS) insertion.
Main Results:
- Antiparkinsonian drug treatment over one year yielded minimal improvement in the patient's condition.
- Following VPS insertion for NPH, significant resolution of both physical and mental symptoms was observed.
- The patient's aggressive outbursts and personality changes were notably improved post-surgery.
Conclusions:
- Normal pressure hydrocephalus (NPH) can mimic or coexist with Parkinson's disease, leading to diagnostic challenges.
- Ventriculo-peritoneal shunt (VPS) placement is an effective treatment for NPH, improving neurological and psychiatric symptoms.
- Comprehensive diagnostic evaluation is crucial for elderly patients presenting with complex neurological and behavioral symptoms.
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