Movement disorders in adult hydrocephalus

Abstract

In a prospective series of symptomatic adult hydrocephalus characterized by gait disturbance, cognitive impairment, and/or urinary incontinence, 88 of 118 patients (75%) had additional akinetic, tremulous, hypertonic, or hyperkinetic movement disorders. Their prevalence was highest in patients with idiopathic normal pressure hydrocephalus (NPH) of the elderly (56/65 patients, 86%), and they were less frequent in patients with secondary NPH (10/15, 66%), with nonhydrodynamic atrophic/other hydrocephalus (20/33, 61%), and with obstructive hydrocephalus/aqueductal stenosis (2/5, 40%). Akinetic symptoms were found in 73 of 118 patients (62%), and the most frequent movement disorder was upper extremity bradykinesia (55%). Akinetic, tremulous, hypertonic, and hyperkinetic movement disorders were exclusively secondary to causes not related to hydrocephalus in 24 of 118 patients (20%). The proportion of patients with movement disorders not attributable to only such causes was highest in the idiopathic NPH group (44/65, 68%). Thirteen of 118 patients (11%) presented with a parkinsonian syndrome. There was evidence for coexistent Parkinson's disease in four of these patients. Parkinsonism was found to be secondary to NPH in five patients and was found improved after shunting. Akinetic symptoms in patients with NPH generally responded favorably to CSF diversion, which was evident in 80% of a subset of this group. Various other movement disorders did not show definite improvement. The high prevalence of bradykinesia and other akinetic symptoms in NPH and the beneficial effect of shunting on such symptoms suggest that NPH may cause a more generalized disorder of motor function.

Recovery Process of Gait Disturbance after Ventriculo-Peritoneal Shunt in Patients with Idiopathic Normal Pressure Hydrocephalus

“…Hydrocephalus can induce parkinsonism. Krauss et al reported that the prevalence of parkinsonism was highest in elderly patients with iNPH 8) . In our previous study, we investigated the characteristics of movement disorders of NPH using motor aspects of UPDRS.…”

Dementia in Parkinson's Disease: A Clinical Review

“…If on the one hand a symptom triad of NPH can easily be found in PD dementia, on the other there are many anecdotal reports of NPH causing parkinsonism. While someone could argue that these patients were carriers of PD and NPH, the reversibility of extrapyramidal symptoms with CSF drainage and the lack of response to levodopa speak against this comorbidity (Krauss et al, 1997;Factora and Luciano, 2008). The differential diagnosis between these two entities, however, offers no great difficulty, since neuroimaging always show an exuberant dilatation of ventricles in NPH cases, an absent feature in cases of PD dementia.…”

Diagnostics of idiopathic normal pressure hydrocephalus: literature review

“…При ИÃНД наблюдают неадекватный угол подъема стопы и уменьшение длины шага. Ширина шага и угол поворота стопы, соответственно, увеличиваются [20].…”

“…В положении лежа больные испытывают значительные трудно-сти при повороте и/или изменении положения тела либо при этом имитируют шагающие движения. Неподвижность, дрожание, гиперкинез описаны у пациентов при ÃНД, чаще при идиопатической форме заболевания [20]. Отмечают брадикинезию верхних конечностей у 50% пациентов при ÃНД.…”