Early Presentation and Management of Normal Pressure Hydrocephalus in a Middle-Aged Patient: A Case Report

Normal pressure hydrocephalus (NPH) is an uncommon neurological disorder that is most often seen in adults over 60 years of age. Its pathogenesis remains uncertain but is believed to involve impaired cerebrospinal fluid (CSF) absorption, increased resistance to CSF outflow, or a mismatch between CSF production and resorption. Reports of NPH in patients younger than 60 are rare, as advanced age is closely associated with the condition. We describe a 55-year-old woman who presented to the emergency department with progressive ataxia, cognitive slowing, and urinary incontinence. Brain imaging demonstrated ventriculomegaly consistent with NPH, and she underwent continuous lumbar drainage with marked clinical improvement. She subsequently participated in an inpatient rehabilitation program, which resulted in further gains in mobility and cognition. Our case highlights the importance of considering NPH in middle-aged patients presenting with compatible symptoms and imaging findings, as timely intervention can lead to meaningful recovery.