Korean J Psychosom Med.  2015 Jun;23(1):66-69. 10.0000/kjpm.2015.23.1.66.

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

• Jang SH
• Jae YM
• Choi JH
• Bae JH
• Seong SY
• Cho SH
• Kim YH

• KMID: 2071081
• DOI: http://doi.org/10.0000/kjpm.2015.23.1.66

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.

Keyword

Normal pressure hydrocephalus; Classical triad; Extrapyramidal signs; Neuropsychiatric symptoms

MeSH Terms

Antiparkinson Agents
Anxiety*
Bipolar Disorder*
Brain
Dementia
Diagnosis, Differential
Dihydroergotamine
Drainage
Female
Gait*
Humans
Hydrocephalus, Normal Pressure*
Hypokinesia*
Mood Disorders
Negotiating
Neuroimaging
Psychomotor Agitation
Urinary Incontinence
Antiparkinson Agents
Dihydroergotamine