Browse > Article
http://dx.doi.org/10.22722/KJPM.2015.23.1.066

Bradykinesia, Rigidity and Gait Disturbance Due to "Possible" Normal Pressure Hydrocephalus in a Patient with Anxiety and Bipolar Disorder : A Case Report  

Jang, Sae Heon (Department of Psychiatry, Bongseng Memorial Hospital)
Jae, Young Myo (Department of Psychiatry, Bongseng Memorial Hospital)
Choi, Jin Hyuk (Department of Psychiatry, Bongseng Memorial Hospital)
Bae, Jung Hoon (Department of Psychiatry, Bongseng Memorial Hospital)
Seong, Sang Yoon (Department of Psychiatry, Bongseng Memorial Hospital)
Cho, Se Hoon (Department of Psychiatry, Bongseng Memorial Hospital)
Kim, Young Hoon (Department of Psychiatry, Bongseng Memorial Hospital)
Publication Information
Korean Journal of Psychosomatic Medicine / v.23, no.1, 2015 , pp. 66-69 More about this Journal
Abstract
In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.
Keywords
Normal pressure hydrocephalus; Classical triad; Extrapyramidal signs; Neuropsychiatric symptoms;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic Occult Hydrocephalus with "Normal" Cerebrospinal-Fluid Pressure. A Treatable Syndrome. N Engl J Med 1965;273:117-126.   DOI
2 Silverberg GD. Normal pressure hydrocephalus(NPH): ischaemia, CSF stagnation or both. Brain 2004;127(Pt 5):947-948.   DOI
3 Krauss JK, Regel JP, Droste DW, Orszagh M, Borremans JJ, Vach W. Movement disorders in adult hydrocephalus. MovDisord 1997;12:53-60.
4 Curran T, Lang AE. Parkinsonian syndromes associated with hydrocephalus: case reports, a review of the literature, and pathophysiological hypotheses. Mov Disord 1994;9:508-520.   DOI
5 Mandir AS, Hilfiker J, Thomas G, Minahan RE, Crawford TO, Williams MA, Rigamonti D. Extrapyramidal signs in normal pressure hydrocephalus: an objective assessment. Cerebrospinal Fluid Res 2007;4:7.   DOI
6 Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005;57(3 Suppl):S4-16; discussion ii-v.   DOI
7 Marmarou A, Bergsneider M, Klinge P, Relkin N, Black PM. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery 2005;57(3 Suppl):S17-28; discussion ii-v.
8 Knutsson E, Lying-Tunell U. Gait apraxia in normal-pressure hydrocephalus: patterns of movement and muscle activation. Neurology 1985;35:155-160.   DOI
9 Ahlberg J, Norlen L, Blomstrand C, Wikkelso C. Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar puncture. J Neurol Neurosurg Psychiatry 1988;51:105-108.   DOI
10 Lanctot KL, Moosa S, Herrmann N, Leibovitch FS, Rothenburg L, Cotter A, Black SE. A SPECT study of apathy in Alzheimer's disease. Dement Geriatr Cogn Disord 2007;24:65-72.   DOI
11 Marshall GA, Monserratt L, Harwood D, Mandelkern M, Cummings JL, Sultzer DL. Positron emission tomography metabolic correlates of apathy in Alzheimer disease. Arch Neurol 2007;64:1015-1020.   DOI
12 Klinge PM, Brooks DJ, Samii A, Weckesser E, van den Hoff J, Fricke H, Brinker T, Knapp WH, Berding G. Correlates of local cerebral blood flow(CBF) in normal pressure hydrocephalus patients before and after shunting--A retrospective analysis of [(15)O]H(2)O PET-CBF studies in 65 patients. Clin Neurol Neurosurg 2008;110:369-375.   DOI
13 Takeuchi T, Goto H, Izaki K, Tamura S, Tomii M, Sasanuma J, Maeno K, Kikuchi Y, Koizumi J, Watanabe Z, Numazawa S, Itoh Y, Watanabe K, Kojima M, Mishima M, Onishi Y, Okada T, Arai T. Pathophysiology of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus. Neurol Med Chir(Tokyo) 2007;47:299-306; discussion   DOI
14 Antonucci AS, Gansler DA, Tan S, Bhadelia R, Patz S, Fulwiler C. Orbitofrontal correlates of aggression and impulsivity in psychiatric patients. Psychiatry Res 2006;147:213-220.   DOI
15 Tullberg M, Hellstrom P, Piechnik SK, Starmark JE, Wikkelso C. Impaired wakefulness is associated with reduced anterior cingulate CBF in patients with normal pressure hydrocephalus. Acta Neurol Scand 2004;110:322-330.   DOI
16 Charney DS, Deutch A. A functional neuroanatomy of anxiety and fear: implications for the pathophysiology and treatment of anxiety disorders. Crit Rev Neurobiol 1996;10:419-446.   DOI
17 McMurtray AM, Chen AK, Shapira JS, Chow TW, Mishkin F, Miller BL, Mendez MF. Variations in regional SPECT hypoperfusion and clinical features in frontotemporal dementia. Neurology 2006;66:517-522.   DOI
18 Miyamoto J, Tatsuzawa K, Inoue Y, Imahori Y, Mineura K. Oxygen metabolism changes in patients with idiopathic normal pressure hydrocephalus before and after shunting operation. Acta Neurol Scand 2007;116:137-143.