MOVEMENT-DISORDERS IN ADULT HYDROCEPHALUS

In a prospective series of symptomatic adult hydrocephalus characteriz ed by gait disturbance, cognitive impairment, and/or urinary incontine nce, 88 of 118 patients (75%) had additional akinetic, tremulous, hype rtonic, or hyperkinetic movement disorders. Their prevalence was highe st in patients with idiopathic normal pressure hydrocephalus (NPH) of the elderly (56/65 patients, 86%), and they were less frequent in pati ents with secondary NPH (10/15, 66%), with nonhydrodynamic atrophic/ot her hydrocephalus (20/33, 61%), and with obstructive hydrocephalus/aqu eductal stenosis (2/5, 40%). Akinetic symptoms were found in 73 of 118 patients (62%), and the most frequent movement disorder was upper ext remity bradykinesia (55%). Akinetic, tremulous, hypertonic, and hyperk inetic movement disorders were exclusively secondary to causes not rel ated to hydrocephalus in 24 of 118 patients (20%). The proportion of p atients with movement disorders not attributable to only such causes w as highest in the idiopathic NPH group (44/65, 68%). Thirteen of 118 p atients (11%) presented with a parkinsonian syndrome. There was eviden ce for coexistent Parkinson's disease in four of these patients. Parki nsonism was found to be secondary to NPH in five patients and was foun d improved after shunting. Akinetic symptoms in patients with NPH gene rally responded favorably to CSF diversion, which was evident in 80% o f a subset of this group. Various other movement disorders did not sho w 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 mo tor function.