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Diagnosis and differential diagnosis of Parkinson’s disease
Published in Jeremy Playfer, John Hindle, Andrew Lees, Parkinson's Disease in the Older Patient, 2018
The clinical syndrome of NPH includes the gradual onset of gait disturbance, incontinence and dementia, but all three components may not always be present. The gait abnormalities may comprise elements of magnetic gait, start hesitation, apraxia and ataxia with a lurching quality. Characteristic features include a wide base, normal leg function when recumbent, poor tandem gait, brisk leg tendon jerks and spasticity. In addition to gait disturbance, other typical features of parkinsonism have been described in NPH, including rest tremor, hypomimia, hypophonia, decreased arm swing, akinesia and rigidity.140 Parkinsonism may or may not improve with levodopa.140
Dementia Associated with Medical Conditions
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
The cognitive impairment seen in INPH is most consistent with a subcortical dementia, characterized by slowed thinking or bradyphrenia, psychomotor slowing (as in fine motor speed and accuracy), inattentiveness, memory encoding and recall problems, and apathy (Hellström et al., 2007). The latter symptoms may result from increased intracranial pressure on the frontal lobes, especially the superior frontal gyrus. In terms of the clinical presentation, the abnormal gait is characteristically wide-based with slow, shuffling movements in which the feet barely lift from the ground, as if they are magnetically attached (hence the term magnetic gait). Walking up curbs and steps becomes particularly difficult. Patients may complain of having tired or weak legs. Because the gait disturbance is often an early and prominent manifestation of NPH, the condition is often mistaken for Parkinson's disease. The urinary symptoms begin with frequency and urgency, and eventually progress to frank incontinence.
A case of primary central nervous system lymphoma presenting as a shunt complication
Published in British Journal of Neurosurgery, 2023
Roberto J. Perez-Roman, Zachary S. Hubbard, G. Damian Brusko, Robert M. Starke
An 82-year-old female initially presented 5 years ago to an outside hospital with magnetic gait, memory difficulties, and urinary incontinence, consistent with normal pressure hydrocephalus (NPH). She underwent right frontal ventriculoperitoneal (VP) shunt placement, which improved her symptoms (Figure 1(A)). She presented again in June 2017 to an outside hospital with signs consistent with worsening NPH symptoms: worsening gait dysfunction and urinary incontinence without headache or vomiting. Computed tomography (CT) scan at that time did not reveal any abnormalities (Figure 1(B)). Multiple adjustments of her shunt failed to improve her symptoms. The patient ultimately presented to our emergency department several weeks later with worsening magnetic gait, urinary incontinence, and confusion. Patient did not complain of headaches, visual symptoms, or nausea/vomiting. Neurologic examination revealed orientation to self only and sensory disturbances in both the upper and lower limbs. Follow-up CT imaging displayed collapse of the right ventricle (Figure 1(C)). The patient was admitted for revision of shunt with possible septostomy.