NORMAL-PRESSURE HYDROCEPHALUS WITH MISLEADING FEATURES OF IRREVERSIBLE DEMENTIAS - A CASE-REPORT

An 85-year-old man presented with the clinical triad (gait instability , dementia, and bladder and bowel incontinence), the ventriculomegaly, and the normal CSF pressure that characterize normal-pressure hydroce phalus (NPH). Diagnostic uncertainty was raised by an unusually rapid onset and a lack. of initial response to CSF tap tests. Additionally, periodic sharp waves on EEG suggested the possibility of Creutzfeldt-J akob disease, and positron emission tomography (PET) demonstrated a pa ttern of cerebral hypometabolism typical of Alzheimer's disease. Never theless, the diagnosis of NPH was supported by delayed improvement fol lowing CSF tap tests, and it was confirmed by a dramatic clinical reco very after CSF shunting, resolution of the EEG and PET abnormalities, and a normal brain biopsy. NPH remains one of the few reversible cause s of dementia, and the presence of its core features, regardless of ra te of onset or ancillary test results, warrants careful consideration of therapeutic intervention.