Right putamen and claustrum infarction mimicking normal pressure hydrocephalus

Area of Science:

• Neurology
• Neuroimaging
• Gait Disorders

Background:

• Normal pressure hydrocephalus (NPH) is a neurological condition characterized by gait disturbance, cognitive impairment, and urinary incontinence.
• Ventriculoperitoneal shunt (VPS) placement is a common surgical intervention for NPH.
• Accurate diagnosis is crucial as other conditions can mimic NPH symptoms.

Observation:

• A woman in her 70s presented with a 2-year history of sudden-onset gait and cognitive decline.
• Brain imaging revealed ventriculomegaly and chronic infarction in the right putamen and claustrum.
• Despite a lumbar drain trial and VPS placement for suspected NPH, her motor and cognitive symptoms remained largely unchanged.
• Parkinsonism, postural instability, and abnormal gait parameters were noted on examination and gait analysis.
• Levodopa administration did not improve her motor symptoms.

Findings:

• The patient's persistent symptoms and lack of response to NPH treatments suggested an alternative diagnosis.
• The chronic infarction in the right putamen and claustrum was identified as a potential cause of the gait disorder.
• The clinical presentation mimicked NPH but was likely a higher-level gait disorder secondary to cerebrovascular injury.

Implications:

• This case highlights the importance of considering cerebrovascular disease in the differential diagnosis of NPH.
• Accurate neuroimaging and clinical correlation are essential for differentiating NPH from other gait disorders.
• Understanding the impact of focal brain lesions on gait can improve diagnostic accuracy and patient management.