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Psychotic symptoms in normal pressure hydrocephalus.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Normal
Pressure
Hydrocephalus
due
to
idiopathic
aqueductal
stenosis
is
a
chronic
abnormal
accumulation
of
cerebrospinal
fluid
in
the
cerebral
ventricles
caused
by
an
obstruction
in
the
Sylvian
aqueduct
.
This
leads
to
a
dilatation
of
the
ventricular
system
and
to
subsequent
damage
of
the
adjacent
parenchyma
.
Although
NPH
typically
presents
with
the
progressive
'
triad
'
of
cognitive
impairment
,
gait
disturbance
and
urinary
incontinence
,
it
has
been
described
that
it
rarely
manifests
in
the
form
of
predominant
psychotic
symptoms
.
It
has
been
suggested
that
thought
and
perceptual
disorders
could
develop
secondary
to
the
damage
caused
by
NPH
.
Although
precise
anatomical
correlates
have
not
yet
been
established
,
certain
cerebral
regions
-
primarily
the
frontal
cortex
,
mesencephalic
and
diencephalic
structures
of
the
brain
-
have
been
implicated
in
the
pathogenesis
of
hydrocephalic
psychosis
.
Because
frontal
lobe
lesions
are
traditionally
known
to
facilitate
one
's
inability
to
integrate
and
correct
perceptual
distortions
in
the
face
of
contradictory
evidence
,
frontal
lobe
dysfunction
may
be
integral
in
delineating
the
etiology
of
delusions
in
NPH
.
We
present
the
case
of
a
30
-
year
-old
female
,
admitted
involuntarily
to
our
acute
psychiatric
department
because
she
exhibited
aggressive
behavior
while
being
in
an
agitated
state
with
delusions
of
persecution
.
Her
neurological
examination
disclosed
subtle
bradykinesia
.
Neuropsychological
batteries
and
intelligence
testing
revealed
mild
cognitive
impairment
and
a
CT
scan
showed
considerable
dilatation
of
the
ventricular
system
due
to
idiopathic
aqueductal
stenosis
.
While
a
conservative
approach
was
chosen
for
the
treatment
of
NPH
,
our
patient
was
initiated
on
2nd
generation
antipsychotics
showing
marked
improvement
of
her
psychiatric
symptomatology
.
The
atypical
presentation
of
hydrocephalus
in
the
aforementioned
case
underlines
the
necessity
to
thoroughly
investigate
the
possible
presence
of
an
underlying
organic
factor
in
those
patients
who
present
with
predominant
psychotic
symptoms
in
association
with
soft
non-localising
neurological
signs
and
mild
cognitive
deficits
.
Furthermore
,
our
patient
's
marked
improvement
indicates
that
,
in
cases
where
the
primary
cause
is
treated
conservatively
,
hydrocephalic
psychosis
could
respond
to
2nd
generation
antipsychotics
.
In
light
of
this
case
report
,
we
reviewed
past
and
present
literature
on
the
matter
.
Diseases
Validation
Diseases presenting
"acute psychiatric department"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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