Hydrocephalic Parkinsonism: lessons from normal pressure hydrocephalus mimics

Area of Science:

• Neurology
• Neuroscience
• Pathology

Background:

• Hydrocephalus is an under-recognized presentation of progressive supranuclear palsy (PSP) and dementia with Lewy bodies (DLB).
• Atypical parkinsonisms can present with hydrocephalus-like symptoms, complicating diagnosis.

Purpose of the Study:

• To describe NPH-like presentations in pathology-proven PSP and DLB.
• To review the literature on hydrocephalic presentations of atypical parkinsonisms.

Main Methods:

• Case series of four patients with NPH-like presentations (3 PSP, 1 DLB).
• Literature review of hydrocephalic presentations in PSP and DLB.

Main Results:

• Patients with NPH-like symptoms showed early postural or oculomotor abnormalities, prompting diagnostic revision.
• Hallucinations were the sole early atypical sign in the hydrocephalic DLB case.
• Ventriculomegaly was disproportionate to parenchymal atrophy in these cases.

Conclusions:

• Early postural impairment, falls, oculomotor issues, or hallucinations in NPH-like cases suggest underlying PSP or DLB.
• These symptoms are inconsistent with a primary NPH diagnosis.
• Previously reported "dual" pathology cases may represent hydrocephalic presentations of neurodegenerative disorders.