A Case of Lacunar Stroke in a Patient with Possible Normal Pressure Hydrocephalus (NPH)

Normal pressure hydrocephalus (NPH) is a condition seen in the elderly, characterized by gait disturbances, urinary incontinence, and cognitive impairment. However, sudden onset neurological deficits suggest a vascular event rather than NPH.

We report a case of a 65-year-old male who presented with sudden onset gait difficulty and speech impairment, initially suspected to be idiopathic NPH. The diagnostic process and management strategies are discussed.

The patient's symptoms, including insidious gait difficulties, speech impairment, and memory loss, led to a suspected diagnosis of NPH. However, the sudden improvement of neurological deficits indicated a vascular cause. Computed Tomography (CT) imaging identified supporting evidence of a lacunar stroke, leading to a revised diagnosis.

This case highlights the importance of considering vascular events in the differential diagnosis of NPH, especially when sudden neurological deficits improve rapidly. Early identification and differentiation between NPH and vascular events are crucial for appropriate management, particularly in low-resource settings.