NR AKPN
AU Schwarzschild,M.; Rordorf,G.; Bekken,K.; Buonanno,F.; Schmahmann,J.D.
TI Normal-pressure hydrocephalus with misleading features of irreversible dementias: a case report.
QU Journal of Geriatric Psychiatry and Neurology 1997 Apr; 10(2): 51-4
PT journal article
AB An 85-year-old man presented with the clinical triad (gait instability, dementia, and bladder and bowel incontinence), the ventriculomegaly, and the normal CSF pressure that characterize normal-pressure hydrocephalus (NPH). Diagnostic uncertainty was raised by an unusually rapid onset and a lack of initial response to CSF tap tests. Additionally, periodic sharp waves on EEG suggested the possibility of Creutzfeldt-Jakob disease, and positron emission tomography (PET) demonstrated a pattern of cerebral hypometabolism typical of Alzheimer's disease. Nevertheless, the diagnosis of NPH was supported by delayed improvement following CSF tap tests, and it was confirmed by a dramatic clinical recovery after CSF shunting, resolution of the EEG and PET abnormalities, and a normal brain biopsy. NPH remains one of the few reversible causes of dementia, and the presence of its core features, regardless of rate of onset or ancillary test results, warrants careful consideration of therapeutic intervention.
MH Activities of Daily Living/classification; Aged; Aged, 80 and over; Alzheimer Disease/diagnosis; Case Report; Creutzfeldt-Jakob Syndrome/diagnosis; Dementia/diagnosis/*etiology/surgery; Diagnosis, Differential; Electroencephalography; Human; Hydrocephalus, Normal Pressure/*complications/diagnosis/surgery; Male; Neurologic Examination; Postoperative Complications/diagnosis; Tomography, Emission-Computed; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt
AD Department of Neurology, Massachusetts General Hospital, Boston 02114, USA
SP englisch
PO USA