Gait Disorder is the Cardinal Sign of Normal Pressure Hydrocephalus: A Case Study

Lt. John J. Fraser; Cira Fraser

Disclosures

J Neurosci Nurs. 2007;39(6):132-134,192. 

In This Article

Abstract and Introduction

Abstract

Normal pressure hydrocephalus (NPH) is one of the few reversible causes of dementia in older adults and accounts for approximately 6% of all dementias. The cardinal sign of NPH is a hypokinetic gait disorder in which the older adult's feet look as though they are glued to the floor. The gait also has been described as magnetic. People with NPH also may have mild dementia and bladder and bowel incontinence. A 78-year-old man exhibited symptoms of NPH for at least 4 years before being diagnosed. A neurological assessment of the patient revealed gait, posture, and balance abnormalities; mild dementia; and urinary urgency, frequency, nocturia, and incontinence at least once a day. His risk factors for NPH included diabetes and hypertension. A computed tomography (CT) scan revealed dilated lateral ventricles in the brain. A lumbar puncture was used to remove 50 ml of cerebrospinal fluid, which resulted in a transient improvement in his gait for approximately 18 hours. A ventriculoperitoneal shunt was then inserted in the patient, and during a 1-year period his symptoms gradually improved. He recovered without any complications and was eventually able to resume his usual activities. When the gait associated with NPH is observed in an older adult, he or she should be referred to a neurologist or multidisciplinary team for a comprehensive evaluation. If an individual receives treatment for NPH, he or she may have an improved quality of life and the opportunity to reduce functional limitations and disability. Families may also experience positive outcomes, such as having a loved one who is cognitively improved and requires less care.

Introduction

Normal pressure hydrocephalus (NPH) is an often overlooked cause of hypokinetic gait disorders in older adults (Stolze et al., 2000). The gait of individuals with NPH is distinct and appears as though their feet are glued to the floor as they try to ambulate; the gait has also been described as magnetic (Weiner, Constantini, Cohen, & Wisoff, 1995). NPH is one of the few reversible causes of dementia in older adults and accounts for approximately 6% of all dementias (Schwarzschild, Rordorf, Bekken, Buonanno, & Schmahmann, 1997). Early recognition of the gait disorder caused by NPH and referral to a neurologist may result in improved outcomes for individuals who might otherwise go untreated. The case study presented in this article is based on the coauthors' experience with a family member who was misdiagnosed for at least 4 years, then successfully treated at the age of 78 years.

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