گزارشی در مورد هیدروسفالی فشار عادی ایدیوپاتیک با لکنت زبان
ABSTRACT
INTRODUCTION
CASE REPORTS
DISCUSSION
CONCLUSION
REFERENCES
ABSTRACT
Idiopathic normal pressure hydrocephalus (iNPH) is a disorder of aging that is characterized by enlarged cerebral ventricles, gait apraxia, dementia, and urinary incontinence. iNPH is frequently misdiagnosed, in part because the symptoms resemble other neurological disorders, and because other associated symptoms have not been fully characterized. Importantly, iNPH has not previously been associated with stuttering, and shunting has not been shown to alleviate the symptom of stuttering. Here, the authors report two cases of patients with iNPH presenting with stuttering that resolved after ventriculoperitoneal (VP) shunt placement. Each patient presented with gait difficulty, incontinence, cognitive impairment and stuttering. Lasting improvements of the symptoms (including stuttering) were seen in both patients after CSF drainage procedures that included lumbar puncture, extended lumbar CSF drainage, placement of a VP shunt, and VP shunt revision.
INTRODUCTION
Normal pressure hydrocephalus (NPH) is a neurological disorder of aging that is characterized by enlarged ventricles, gait difficulty, incontinence, cognitive impairment, and normal (or only slightly elevated) intracranial pressure. Patients with NPH are diagnosed as having primary (idiopathic) or secondary NPH, based on the etiology of the disease. Secondary NPH can affect individuals of any age. Common causes are subarachnoid hemorrhage, head trauma and meningitis, all of which may lead to increased brain inflammation and fibrosis of CSF resorption pathways. Idiopathic NPH (iNPH) is most commonly seen in adults over the age of 60. The pathophysiology of iNPH is poorly understood. Proposed mechanisms suggest decreased cerebral blood flow, poor cerebral vascular autoregulation, and impaired CSF production, absorption, and turnover rate. The treatment for NPH, regardless of etiology, is the placement of a ventriculoperitoneal (VP) shunt . iNPH remains a difficult disease to diagnosis, given its late age of onset and the notable overlap of its presenting symptoms with other diseases of aging, including Lewy body dementia, Parkinson’s Disease, progressive supranuclear palsy, and Alzheimer’s Disease . To date, however, there are no reports that describe stuttering or dysarthria as presenting symptoms in iNPH. This case report describes two patients who presented with iNPH symptoms with stuttering, and who displayed sustained symptomatic improvement after VP shunt placement.