The Challenges of Normal Pressure Hydrocephalus: A Case-Based Review

CONCLUSION
As the case illustrates, the diagnosis of iNPH is not always apparent or easy to make. In this instance, there was a five-year delay between onset of symptoms and diagnosis. Multiple providers were consulted, and several misdiagnoses (depression, Parkinson disease, Alzheimer disease) were pursued while the symptoms of iNPH continued to develop­—a common occurrence in many iNPH cases.

Because of the insidious onset, symptoms of iNPH often go unnoticed or are ignored, minimized, or overlooked by both patients and providers. It is not uncommon for clinicians to misdiagnose gait instability as a sign of Parkinson disease and cognitive impairment as early dementia (especially Alzheimer disease), or to attribute urinary frequency and urgency to benign prostatic hypertrophy in men. A high index of suspicion among providers and early diagnosis are important, as it is now well established that early intervention with VP shunt can have a dramatic impact on symptoms in the majority of patients with iNPH.