Delayed Normal Pressure Hydrocephalus after Deep Brain Stimulation in Parkinson's Disease.

Area of Science:

• Neurology
• Neurosurgery

Background:

• Deep brain stimulation (DBS) of the subthalamic nuclei (STN) or globus pallidus internus (GPi) is effective for Parkinson's disease (PD) and dystonia.
• While acute complications of DBS are known, delayed complications like normal pressure hydrocephalus (NPH) have not been previously reported.

Observation:

• A case series identified seven Parkinson's disease patients who developed NPH an average of 10.9 years after undergoing DBS (6 STN, 1 GPi).
• These patients presented with cognitive decline and gait disturbances, classic symptoms of NPH.

Findings:

• Imaging studies confirmed hydrocephalus meeting NPH criteria (Radscale >4) in these patients.
• Cerebrospinal fluid (CSF) tap tests further validated the NPH diagnosis.
• Treatment with ventriculoperitoneal shunt placement resulted in significant improvement of NPH symptoms.

Implications:

• This study highlights the importance of considering NPH as a potential delayed complication following DBS in Parkinson's disease patients.
• Early diagnosis and intervention, such as CSF shunting, are crucial for managing NPH and improving functional outcomes in this patient population.
• Further research is warranted to understand the mechanisms linking DBS and the development of NPH.