Idiopathic normal pressure hydrocephalus presenting with epileptic seizure as a cardinal symptom: A case presentation

Eleftheriou, Andreas; Amezcua, Salvador; Nilsson, Marie

doi:10.1016/j.inat.2019.100618

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…One study stated that the severity of bulbar symptoms was directly associated with the increasing severity of the NPH triad [ 6 ]. Eleftheriou et al also documented bulbar dysfunction as one of the manifestations of NPH [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Bulbar Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Case Report

Usama¹,

Arora²,

Saleem³

2023

Cureus

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Normal pressure hydrocephalus (NPH) is a rare condition characterized by pathologically enlarged ventricles and a normal cerebrospinal fluid (CSF) opening pressure measured by lumbar puncture. NPH typically presents as a triad of cognitive decline, gait disturbance, and urinary incontinence. Rarely, NPH can present with bulbar involvement, particularly with difficulty swallowing. Here, we present a case of NPH in a 75year-old man who presented with an episode of choking and a recent onset of swallowing difficulties with a three-month history of ataxia and progressive memory loss. His CT scan revealed ventriculomegaly, which was consistent with the clinical presentation of NPH and was further confirmed by a normal opening pressure on the CSF tap. Furthermore, ventriculoperitoneal shunts showed a marked improvement in patients' dysphagia and the classical triad of NPH symptoms. Through this case report, we want to highlight that NPH can present as a difficulty in swallowing.

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Section: Discussionmentioning

confidence: 99%

Bulbar Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Case Report

Usama¹,

Arora²,

Saleem³

2023

Cureus

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“…Previous studies have shown that postoperative complications of iNPH include seizures, although these are rare, at 0.16% 37 . However, nonsurgical iNPH presenting with seizures is even rarer, and there has been only one similar case report to our knowledge 38 . Epilepsy of elderly origin is generally a partial seizure, nonconvulsive status epilepticus (NCSE).…”

Section: Discussionmentioning

confidence: 99%

A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy

石田¹,

Murayama

Kobayashi

2022

PCN Reports

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Background Idiopathic normal pressure hydrocephalus (iNPH) is a common form of dementia that causes gait disturbance, cognitive impairment, and urinary incontinence. iNPH is a “treatable dementia” that can be treated with shunt surgery, but this can be ineffective in some cases and can be accompanied by complications. As a result, many patients with iNPH do not undergo surgery. However, there is insufficient evidence on effective treatments other than surgical therapy. Case Presentation A 75‐year‐old woman presented to our hospital with a chief complaint of cognitive decline. She showed reduced motivation and inactivity. Brain magnetic resonance imaging showed a high score on the Evans Index (maximum width between bilateral lateral ventricular anterior horns/maximum intracranial cavity in the same slice). The subarachnoid space was enlarged at and below the Sylvian fissure, and narrowed at the higher arcuate region. She was diagnosed with iNPH. However, no shunt surgery was performed; 11 months later, she had a generalized convulsive seizure with loss of consciousness. An electroencephalogram showed generalized epileptic discharges. The possibility of surgery for her iNPH was ruled out. Levetiracetam prevented seizure recurrence and cognitive functions such as spontaneity and motivation were improved. Conclusion It is often assumed that surgery is the only effective treatment for patients with iNPH. However, as in the present case, symptomatic epileptic seizures may be a factor in dementia. Even in the absence of surgical treatment, we should examine the cause of dementia in patients with iNPH and consider pharmacological treatment, including antiepileptic drugs.

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“…Two case reports have been published on nonsurgical iNPH presenting with seizures. In the first case, hyponatraemia associated with the administration of laxatives following lower gastrointestinal endoscopy triggered an epileptic seizure[ 54 ]. In the other case, a change in diagnosis and treatment from donepezil treatment for Alzheimer's disease to levetiracetam treatment for symptomatic epileptic seizures associated with iNPH resulted in improved cognitive function[ 55 ].…”

Section: Epilepsymentioning

confidence: 99%

Current research of idiopathic normal pressure hydrocephalus: Pathogenesis, diagnosis and treatment

石田¹,

Murayama²,

Kobayashi³

2023

World J Clin Cases

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Idiopathic normal pressure hydrocephalus (iNPH) is caused by impaired cerebrospinal fluid absorption in the elderly; it is a surgically treatable form of dementia. Gait disturbance, dementia, and urinary incontinence are the triad of signs for iNPH. In addition to these clinical findings, imaging studies show characteristic ventricular enlargement. High Evans Index and ‘disproportionately enlarged subarachnoid hydrocephalus’ are other well-known imaging findings of iNPH. If the tap test shows improved symptoms, shunt surgery is performed. The disease was first described by Hakim and Adams in 1965, followed by the publication of the first, second, and third editions of the guidelines in 2004, 2012, and 2020, respectively. Recent studies signal the glymphatic system and classical cerebrospinal fluid (CSF) absorption from the dural lymphatics as aetiological mechanisms of CSF retention. Research is also underway on imaging test and biomarker developments for more precise diagnosis, shunting technique options with fewer sequelae and complications, and the influence of genetics. Particularly, the newly introduced ‘suspected iNPH’ in the third edition of the guidelines may be useful for earlier diagnosis. However, less well-studied areas remain, such as pharmacotherapy in non-operative indications and neurological findings other than the triadic signs. This review briefly presents previous research on these and future issues.

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Idiopathic normal pressure hydrocephalus presenting with epileptic seizure as a cardinal symptom: A case presentation

Cited by 6 publications

References 5 publications

Bulbar Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Case Report

Bulbar Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Case Report

A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy

Current research of idiopathic normal pressure hydrocephalus: Pathogenesis, diagnosis and treatment

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