Psychotic symptoms in normal-pressure hydrocephalus

Area of Science:

• Neurology
• Psychiatry

Background:

• Normal-pressure hydrocephalus (NPH) is a neurological condition often presenting with gait disturbance, urinary incontinence, and dementia.
• Psychiatric manifestations can sometimes mask or be mistaken for primary psychiatric disorders, complicating diagnosis.

Observation:

• Two patients with long-standing psychiatric histories and clinical/neuroradiological signs of NPH were studied.
• One patient had periodic psychosis post-tuberculous meningitis, overshadowing mild NPH symptoms, and received extensive electro-convulsive therapy.
• The second patient presented with paranoid psychosis and moderate, progressive NPH signs.

Findings:

• Both patients experienced significant improvement in NPH symptoms following ventriculo-atrial shunting.
• Psychotic symptoms resolved completely in both cases after the surgical intervention.
• One patient showed sustained improvement over a 5-year follow-up; the other succumbed to sepsis 2.5 years post-shunting.

Implications:

• Widespread screening using computerized tomography (CT) for NPH in patients with psychiatric symptoms or dementia, especially with gait disturbance, is recommended.
• Early identification and surgical referral for suspected NPH can lead to substantial clinical and economic benefits.
• This approach highlights the importance of considering neurological causes for psychiatric presentations.