Normal Pressure Hydrocephalus with Primary Presentation of Psychiatric Disturbance: Case Report

Area of Science:

• Neurology
• Psychiatry

Background:

• Normal pressure hydrocephalus (NPH) typically presents with cognitive decline, gait disturbance, and urinary incontinence.
• Anxiety is an uncommon primary manifestation of NPH.

Purpose of the Study:

• To report a unique case of NPH presenting primarily with severe anxiety.
• To highlight the potential for NPH to manifest with psychiatric symptoms.

Main Methods:

• A 63-year-old male presented with severe anxiety, minimal gait changes, and no urinary issues.
• Diagnostic work-up included MRI and SPECT scans, revealing ventriculomegaly and hypoperfusion.
• Treatment involved a large-volume lumbar puncture followed by ventriculoperitoneal shunt placement.

Main Results:

• The patient experienced a dramatic and sustained improvement in anxiety following shunt placement.
• Initial shunting was deferred but became indicated after a positive response to lumbar puncture.

Conclusions:

• This case presents a unique manifestation of NPH symptomology.
• The findings may inform future research and clinical decision-making regarding NPH presentations.