Abstract
Background and Objective Progressive impairment of cognitive function is a common feature seen in patients
with normal pressure hydrocephalus (NPH). Along with cognitive decline, many of the
other classic symptoms of NPH are chronic and rarely present with overwhelming anxiety.
We report the case of a 63-year-old man who presented with recent primary psychiatric
manifestation of severe disabling anxiety and otherwise a minimal change in gait and
no urinary disturbance.
Clinical Presentation The patient's work-up consisted of magnetic resonance imaging that showed moderate
ventriculomegaly but no findings concerning for acute obstructive hydrocephalus. A
single-photon emission computed tomography scan was markedly abnormal with severe
hypoperfusion consistent with hydrocephalus. Initially shunting was not advised but
was eventually performed after a dramatic response to a large-volume lumbar puncture.
After considerable discussion, he underwent elective ventriculoperitoneal shunt placement
and had dramatic and sustained improvement in his anxiety.
Conclusion We believe this case report is a unique description of NPH symptomology and might
guide future research or clinical decision making.
Keywords
anxiety - normal pressure hydrocephalus - psychiatric - ventriculoperitoneal shunt
