Normal Pressure Hydrocephalus with Stroke History: A Case Report and Literature Review

Abstract

Normal pressure hydrocephalus (NPH) is characterized by enlarged ventricles despite normal intracranial pressure, caused by an abnormal build up of cerebrospinal fluid (CSF).It typically presents with the classic triad of symptoms: gait and balance disturbances, urinary
incontinence, and cognitive decline. Unlike many other dementias, NPH is notable because it can often be reversed through surgical intervention, most commonly with ventriculoperitoneal shunt placement, which remains the standard treatment. Case Illustration: A 73-years-old
male presented with loss of consciousness over the past six days, with worsening symptomsone day prior to admission. Associated symptoms included blank stare, no eye contact while  communicating, and blisters all over the body due to a long period of bed rest. He denied any episodes of fever, cough, runny nose, diarrhea, headache, seizure, vomiting, abdominal pain,or fall. There was a history of stroke attacks that happened twice in 2023 and 2024 with sequelae aphasia since then. CT Scan revealed acute lacunar infarct in nucleus lentiformis
dextra, no intracranial haemorrhage presented, cerebral atrophy with ventriculomegaly exvacuo confirmed, there are ethmoidalis and frontalis sinusitis. The patient then treated with ventriculoperitoneal shunt but then passed away two days after the surgery.

Keywords: Hydrocephalus, Stroke, CSF