1/24. Reversible dementia in idiopathic normal pressure hydrocephalus. A case report.OBJECTIVE: To present a woman with idiopathic normal pressure hydrocephalus (NPH) showing marked improvement in mental function after shunt operation. DESIGN: Case report. SETTING: primary health care. PATIENT: The clinical symptoms of gait disturbance, occasional urine incontinence and severely impaired mental function typical of NPH were all present. Although dementia predominated in the clinical picture, the diagnosis was confirmed by computer tomography (CT) and cerebrospinal fluid infusion test and cisternography. MAIN OUTCOME MEASURES: A marked improvement of mental functions was observed after shunt operation. RESULTS: Mini Mental State Examination score before shunt operation was 9 compared with 20 one year after operation. Also ventricle size was reduced as evaluated by CT scan. CONCLUSION: This reported case contrasts previous reports concluding that shunt responsive patients have only slight mental disturbances without significant improvement of mental status after shunt operation.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
2/24. syndrome of inappropriate secretion of antidiuretic hormone associated with idiopathic normal pressure hydrocephalus.A 79-year-old woman suffering from urinary incontinence and unsteady gait was diagnosed as having idiopathic normal pressure hydrocephalus (NPH) with hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The concentration of antidiuretic hormone was high while the plasma osmolality was low in the presence of concentrated urine during the episodes of hyponatremia. magnetic resonance imaging (MRI) of the head showed enlargement of the third and lateral ventricles. After ventriculoperitoneal shunt surgery, the symptoms of NPH and hyponatremia improved. It may be possibly explained that mechanical pressure on the hypothalamus from the third ventricle is responsible for hyponatremia.- - - - - - - - - - ranking = 6.7197674326102keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
3/24. Late onset X-linked hydrocephalus with normal cerebrospinal fluid pressure.A family with X-linked hydrocephalus with normal cerebrospinal fluid (CSF) pressure and in which three brothers and a grandson of case 1, a proband, were affected is reported. The symptoms at onset were epileptic attacks that started in adulthood in the three brothers and at the age of 6 years in the grandson. In the three brothers, from 10 to 27 years after the onset of epileptic episodes, disorganization of intelligence and psychiatric deterioration were gradually noticed by their families. At the same time, they showed occasional urinary incontinence. brain computed tomography (CT) scans revealed dilatation of the ventricular systems. Based on the results of the measurement of CSF pressure and radioactive-iodinated human serum albumin (RISA)-cysternography, two of the brothers were diagnosed as having normal pressure hydrocephalus (NPH), and they were treated neurosurgically. However, no obvious improvement in clinical symptoms was observed. Although the grandson had shown normal psychomotor development during his early childhood, temporal epilepsy and temper tantrums started at the age of 6 years. Computed tomography-scanning revealed dilatation of the ventricular system similar to the other three cases at the age of 8 years. With the diagnosis of NPH, the patient underwent a shunt operation, which resulted in no obvious effects. As it is reasonable to surmise that the pathological gene would have been transferred via the daughter of the proband to the grandson, it is suggested that the inheritance manner might be X-linked recessive. The cases presented here are different from the cases of hydrocephalus due to stenosis of the aqueduct Sylvius (HSAS) and other types of X-linked hydrocephalus reported previously in terms of the age of onset, course, symptoms, and CT findings. Thus, it is suggested that the present cases might be a new type of X-linked hydrocephalus.- - - - - - - - - - ranking = 6.7197674326102keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
4/24. Normal-pressure hydrocephalus due to tentorial meningioma.Normal-pressure hydrocephalus and the associated triad of dementia, apraxic gait and urinary incontinence may be casued by various, sometimes unsuspected, lesions, usually those that block the flow of cerebrospinal fluid (CSF) around the tentorium. A 58-year-old woman with insidious onset of behaviour and gait problems had occult, normal-pressure hydrocephalus and a tentorial meningioma, resection of which produced complete recovery. This case demonstrates that a distinction must be made between the syndrome of normal-pressure hydrocephalus resulting from disturbance in CSF dynamics and the pathophysiologic features of the underlying lesion.- - - - - - - - - - ranking = 6.7197674326102keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
5/24. Normal pressure hydrocephalus found after anesthesia--a case report.Normal pressure hydrocephalus (NPH) is characterized by insidious onset and gradual development of the triad of gait disturbance, dementia, and urinary incontinence. nausea, vomiting, and signs of increased intracranial pressure do not occur. A 71-year-old male patient was scheduled for total knee replacement due to osteoarthritis of right knee joint. No neurological symptoms and signs except mild forgetfulness were detected during physical examination following admission. Due to operational mistakes, the anesthesiologist was informed that the surgery was cancelled just after completion of induction of general anesthesia. The patient was allowed to emerge from anesthesia. Unfortunately, his consciousness became drowsy the next morning. After a series of examinations, he was at last diagnosed as a case of NPH principally by the brain computed tomography scan. So he was scheduled again but this time for vetriculoperitoneal (V-P) shunt. The patient regained consciousness after V-P shunt. From this case, we learned that NPH may remain in concealment in the patients we contacted in our daily practice. A vigilant physician should keep in mind that the presentation of gait disturbance, dementia, and urinary incontinence in a patient may indicate the likelihood of NPH.- - - - - - - - - - ranking = 13.43953486522keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
6/24. Normal pressure hydrocephalus. A potentially reversible form of dementia.1. Normal pressure hydrocephalus (NPH) is a rare but potentially treatable form of dementia. Shunting will improve functioning in 40% to 50% of patients. 2. The classic symptoms of NPH are dementia characterized by mild memory impairment and apathy, ataxic gait, and urinary hesitancy or incontinence. 3. The patient with NPH may present with psychiatric symptoms of depression, paranoia, visual hallucinations, irrational hostility, and aggression or mania. 4. patients with NPH are indifferent about activities of daily living and personal safety and require close supervision.- - - - - - - - - - ranking = 1.0041904467464keywords = incontinence, urinary (Clic here for more details about this article) |
7/24. Normal pressure hydrocephalus in a patient with myotonic dystrophy: case report with a 10-year follow-up.OBJECTIVE AND IMPORTANCE: myotonic dystrophy (MD) is the most common adult muscular dystrophy involving multiple organs. Normal pressure hydrocephalus (NPH) is characterized by gait apraxia, urinary incontinence, and dementia. NPH in association with MD has been reported in only three cases. This report provides for the first time the complete evaluation, treatment, and long-term follow-up of a patient with NPH and MD. CLINICAL PRESENTATION: A 61-year-old man known to have MD complained of 4 years of progressive deterioration of long-term memory and gait disturbance, which was the main clinical feature. Computed tomography scan and magnetic resonance imaging showed ventricular enlargement. intracranial pressure monitoring showed B waves with amplitude superior to 9 mm Hg in more than 5% of the recording. TECHNIQUE: We performed a ventriculoperitoneal shunt with clear postoperative improvement, confirming the diagnosis of NPH. The clinical improvement has remained stable through prolonged follow-up. CONCLUSION: association between MD and NPH could be more than coincidental, and it is important to recognize this potential insidious association because a ventriculoperitoneal shunt can provide excellent long-term clinical improvement.- - - - - - - - - - ranking = 6.7197674326102keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
8/24. cauda equina neurinoma associated with normal pressure hydrocephalus--case report.A 45-year-old male was hospitalized because of gait disturbance, urinary incontinence, and memory disturbance. A computed tomographic (CT) scan revealed dilatation of the cerebral ventricles, and a metrizamide CT scan showed reflux into all ventricles. Cerebrospinal fluid obtained at the time of metrizamide CT was highly xanthochromic. Myelograms demonstrated a tumor between the inferior portion of the fifth lumbar vertebra and that of the second sacral vertebra. After removal of a spinal tumor involving nerve fibers at the cauda equina, his symptoms disappeared and the spinal fluid protein normalized. Three months after surgery, a CT scan revealed reduction of cerebral ventricular size. There are 10 reported cases of spinal tumors resulting in normal pressure hydrocephalus. All these and present cases involved protein in the spinal fluid, which might have been the cause of the hydrocephalus.- - - - - - - - - - ranking = 6.7197674326102keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
9/24. arachnoid cyst mimicking normal pressure hydrocephalus. A case report and review of the literature.A case of a 61-year-old female patient who presents with the clinical triad of normal pressure hydrocephalus (NPH), abnormal gait, urinary incontinence and dementia. On CT scanning, she is found to have a large arachnoid cyst which mimicked the syndrome of NPH. This is also the 60th published case of arachnoid cyst presenting over the age of 60.- - - - - - - - - - ranking = 6.7197674326102keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
10/24. Multiple simultaneous intracerebral hemorrhages following accidental massive lumbar cerebrospinal fluid drainage: case report and literature review.Multiple simultaneous intracerebral hemorrhages (ICH) are uncommon. We report the case of an 80-year-old woman with previous diagnosis of normal pressure hydrocephalus and who was brought to our hospital with altered mental status and urinary incontinence. Medical history of hypertension, hematological disorders or severe head trauma was absent. platelet count and coagulation profile were unremarkable. An initial head computed tomography (CT) showed sulcal enlargement and ventricular dilatation, but no evidence of ICH. A tap test indicated as a guide to case selection for shunt surgery accidentally resulted in cerebrospinal fluid (CSF) overdrainage. The patient presented sudden neurological deterioration, with sluggishly responsive pupils and generalized tonic-clonic seizures. A new head CT demonstrated multiple supra and infratentorial ICH. The patient became comatose and had a fatal course. Hence, CSF overdrainage may either cause or precipitate multiple simultaneous ICHs, affecting both the infratentorial and supratentorial regions.- - - - - - - - - - ranking = 6.7197674326102keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
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