Movement disorders in adult hydrocephalus

Area of Science:

• Neurology
• Neurosurgery
• Movement Disorders

Background:

• Symptomatic adult hydrocephalus often presents with gait disturbance, cognitive impairment, and urinary incontinence.
• Movement disorders are frequently observed in patients with hydrocephalus, but their specific association with different hydrocephalus subtypes requires further investigation.

Purpose of the Study:

• To investigate the prevalence and characteristics of movement disorders in adult hydrocephalus.
• To determine the relationship between specific types of hydrocephalus and the occurrence of movement disorders.
• To assess the impact of cerebrospinal fluid (CSF) diversion on these movement disorders.

Main Methods:

• Prospective study of 118 symptomatic adult hydrocephalus patients.
• Classification of hydrocephalus into idiopathic normal pressure hydrocephalus (NPH), secondary NPH, nonhydrodynamic atrophic/other hydrocephalus, and obstructive hydrocephalus/aqueductal stenosis.
• Detailed assessment of movement disorders, including akinetic, tremulous, hypertonic, and hyperkinetic symptoms, and their potential secondary causes.

Main Results:

• 75% of patients exhibited movement disorders; prevalence was highest in idiopathic NPH (86%).
• Akinetic symptoms, particularly upper extremity bradykinesia (62%), were most common.
• 20% of movement disorders were exclusively due to non-hydrocephalus causes.
• Parkinsonism occurred in 11% of patients, with 5 cases secondary to NPH and improved after shunting.
• Akinetic symptoms in NPH patients responded favorably to CSF diversion in 80% of cases.

Conclusions:

• Movement disorders are highly prevalent in adult hydrocephalus, especially idiopathic NPH.
• Akinetic symptoms and bradykinesia in NPH patients often improve with CSF diversion (shunting).
• Normal pressure hydrocephalus may contribute to a generalized motor function disorder, distinct from coexistent Parkinson's disease.