The Challenges of Normal Pressure Hydrocephalus: A Case-Based Review
Although accreditation for this CE/CME activity has expired, and the posttest is no longer available, you can still read the full article.
Expires December 31, 2016
Idiopathic normal pressure hydrocephalus (iNPH) is one of the few reversible causes ofdementia. Unfortunately, the symptoms of iNPH—cognitive impairment, gait change, andurinary incontinence—develop slowly and are often mistaken for those ofother conditions or for normal aging. This article explains when to suspect iNPHand the steps you need to take when iNPH is in the differential.
CONCLUSION
As the case illustrates, the diagnosis of iNPH is not always apparent or easy to make. In this instance, there was a five-year delay between onset of symptoms and diagnosis. Multiple providers were consulted, and several misdiagnoses (depression, Parkinson disease, Alzheimer disease) were pursued while the symptoms of iNPH continued to develop—a common occurrence in many iNPH cases.
Because of the insidious onset, symptoms of iNPH often go unnoticed or are ignored, minimized, or overlooked by both patients and providers. It is not uncommon for clinicians to misdiagnose gait instability as a sign of Parkinson disease and cognitive impairment as early dementia (especially Alzheimer disease), or to attribute urinary frequency and urgency to benign prostatic hypertrophy in men. A high index of suspicion among providers and early diagnosis are important, as it is now well established that early intervention with VP shunt can have a dramatic impact on symptoms in the majority of patients with iNPH.
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