Idiopathic Normal-Pressure Hydrocephalus Revealed by Systemic Infection: Clinical Observations of Two Cases

Area of Science:

• Neurology
• Neuroscience
• Geriatrics

Background:

• Idiopathic normal-pressure hydrocephalus (iNPH) is a reversible neurological condition affecting gait, cognition, and urinary function.
• Pathophysiology involves impaired cerebrospinal fluid (CSF) absorption, with emerging roles for glymphatic and meningeal lymphatic systems.
• Triggers for clinical iNPH manifestation in subclinical cases are not well understood.

Observation:

• Two cases of iNPH presenting with clinical symptoms after systemic infections are detailed.
• Case 1: An 82-year-old male with sepsis developed transient neurological deficits, improved with shunting.
• Case 2: An 80-year-old male with pre-existing gait/cognitive issues experienced worsening incontinence and infarction during bacteremia, improving post-shunt.

Findings:

• Systemic inflammatory states may precipitate iNPH in susceptible individuals with pre-existing cerebral ischemia or CSF flow abnormalities.
• Neuroimaging in both cases showed characteristic changes such as ventricular enlargement and enlarged subarachnoid spaces.
• Both patients demonstrated significant clinical improvement following CSF shunting procedures.

Implications:

• Increased clinical suspicion for iNPH is warranted in older patients with neurological deterioration during systemic infections.
• Early diagnosis and prompt shunting, after infection control, can lead to substantial functional recovery.
• These cases underscore the interplay between infection, inflammation, and hydrocephalus pathophysiology.