Hydrocephalus As Possible Prodromal Manifestation of COVID-19: A Report of Two Cases

Abstract

Although the etiopathology of normal pressure hydrocephalus (NPH) is still not completely defined, several studies in recent years have highlighted the role of neuro-inflammation mediators in its development.During COVID-19, the infected host develops a multifaceted inflammatory syndrome, that may lead to an uncontrolled immune system response also localized in the host nervous system. In fact, the target of the viral Spike protein, the angiotensin-converting enzyme 2 (ACE2) receptors, is widely expressed in different areas of CNS such as the olfactory epithelium, and the choroid plexus. As for idiopathic NPH, the massive release of inflammatory mediators may result in altered CSF dynamics and consequent sudden clinical decompensation.We report the cases of two patients with a known iNPH condition, in which neurological symptoms suddenly worsened, requiring hospitalization, without any evident precipitating cause. Both patients tested positive for the COVID-19 virus shortly after the neurological impairment, which had occurred, therefore, during the incubation period of the infection.On the basis of our experience we advise, in cases of NPH patients with sudden neurological worsening, to perform a molecular COVID-19 swab at the moment of clinical impairment. We, therefore, recommend considering SARS-CoV-2 infection in the differential diagnosis of a sudden and otherwise unexplainable impairment of hydrocephalic patients. Furthermore, we believe clinicians should invite NPH patients to adopt adequate preventive measures to protect them from SARS-CoV-2 infection.

Hydrocephalus as Possible Neurological Complication of COVID-19: A Case Report and Systematic Literature Review

“…The belief that COVID-19 infection could act as a triggering factor for the development of CSF dynamic disorder (eventually leading to deterioration of previously diagnosed hydrocephalus), is supported by some case reports included in our review [ 14 - 15 ]. Torelli et al [ 14 ] described a case of a 79-year-old unvaccinated man with a history of idiopathic normal pressure hydrocephalus who experienced a worsening of his neurological status during acute COVID-19 infection.…”

“…The belief that COVID-19 infection could act as a triggering factor for the development of CSF dynamic disorder (eventually leading to deterioration of previously diagnosed hydrocephalus), is supported by some case reports included in our review [ 14 - 15 ]. Torelli et al [ 14 ] described a case of a 79-year-old unvaccinated man with a history of idiopathic normal pressure hydrocephalus who experienced a worsening of his neurological status during acute COVID-19 infection. Dai et al [ 15 ] reported a case of a 29-year-old female with a history of non-VP shunt-requiring congenital stenosis of the middle cerebral aqueduct.…”

“…Literature review yielded six studies, four case reports [10][11][12][13] and two case series [14,15] iNPH: idiopatic normal pressure hydrocephalus; ADHD: attention-deficit/hyperactivity disorder According to our review, hydrocephalus onset during or after COVID-19 infection shows in adults an equal distribution among genders (five female, four male) and ages (age interval: 20-79). In almost half of the identified cases, the diagnosis of hydrocephalus was made concomitantly with the diagnosis of COVID-19 infection.…”

“…Two studies [8,9] were removed after reading the full text, because, although they met inclusion criteria, the reported hydrocephalus was to refer to acute SAH. Thus, a total of six articles [10][11][12][13][14][15] were included.…”