{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:09Z","timestamp":1776096489699,"version":"3.50.1"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,1,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Normal pressure hydrocephalus (NPH) is a condition characterized by enlarged intracerebral ventricles with normal intracranial pressure. The typical clinical presentation includes cognitive decline, gait disturbances, and urinary incontinence. While the classic triad of symptoms is well documented, atypical presentations, including focal deficits and aphasia, pose significant diagnostic challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>This is the case of a previously healthy 70-year-old patient presenting with rapidly progressive gait disturbances, right hemiplegia, cognitive decline, and mutism. The focal presentation suggested a left hemispheric cerebrovascular insufficiency. A comprehensive diagnostic workup, including serial imaging, lumbar punctures, and electroencephalography, was undertaken given diagnostic uncertainty. Initial evaluations suggested a left hemispheric stroke or neurodegenerative process, ultimately delaying the definitive diagnosis and treatment of NPH. MRI revealed progressive ventriculomegaly and white matter changes prompting a lumbar drain trial. This yielded clinical improvement and ventriculoperitoneal shunt placement. Postoperatively, the patient had complete resolution of symptoms and returned to a normal functional status within 6 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case demonstrates the diagnostic challenges in differentiating NPH from stroke or neurodegenerative disorders. Recognizing its varied presentations and distinguishing them from other diseases is crucial for initiating appropriate treatment. Early intervention improved this patient\u2019s outcome and prevented unnecessary morbidity, demonstrating the significant impact of accurate and timely diagnosis.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25620\">https:\/\/thejns.org\/doi\/10.3171\/CASE25620<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25620","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T06:29:22Z","timestamp":1769408962000},"source":"Crossref","is-referenced-by-count":0,"title":["Normal pressure hydrocephalus plus atypical presentation with symptomatic resolution following the restoration of CSF flow: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3336-7258","authenticated-orcid":true,"given":"Jordan","family":"Hatfield","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kennedy","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Komisarow","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6258-0205","authenticated-orcid":true,"given":"Joel","family":"Morgenlander","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Semin Pediatr Neurol","first-page":"9","article-title":"A contemporary definition and classification of hydrocephalus","volume":"16","author":"Rekate","year":"2009","unstructured":"Rekate HL.A contemporary definition and classification of hydrocephalus. Semin Pediatr Neurol. 2009;16(1):9-15."},{"issue":"3","key":"bib2","series-title":"Neurosurgery","first-page":"S4","article-title":"Diagnosing idiopathic normal-pressure hydrocephalus","volume":"57","author":"Relkin","year":"2005","unstructured":"Relkin NMarmarou AKlinge PBergsneider MBlack PM.Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(3)(suppl):S4-S16, ii."},{"issue":"2 Dementia","key":"bib3","series-title":"Continuum (Minneap Minn)","first-page":"579","article-title":"Diagnosis and treatment of idiopathic normal pressure hydrocephalus","volume":"22","author":"Williams","year":"2016","unstructured":"Williams MAMalm J.Diagnosis and treatment of idiopathic normal pressure hydrocephalus. Continuum (Minneap Minn). 2016;22(2 Dementia):579-599."},{"issue":"3","key":"bib4","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Epidemiology of adult-onset hydrocephalus: institutional experience with 2001 patients","volume":"41","author":"Bir","year":"2016","unstructured":"Bir SCPatra DPMaiti TKEpidemiology of adult-onset hydrocephalus: institutional experience with 2001 patients. Neurosurg Focus. 2016;41(3):E5."},{"key":"bib5","series-title":"J Neurol Sci","first-page":"120019","article-title":"Parkinsonism and cerebrospinal fluid disorders","volume":"433","author":"Youn","year":"2022","unstructured":"Youn JTodisco MZappia MPacchetti CFasano A.Parkinsonism and cerebrospinal fluid disorders. J Neurol Sci. 2022;433:120019."},{"issue":"5","key":"bib6","series-title":"Neurology","first-page":"e213352","article-title":"Involvement of the nigrostriatal pathway in patients with idiopathic normal pressure hydrocephalus and parkinsonism","volume":"104","author":"Palermo","year":"2025","unstructured":"Palermo GFrancesconi ABellini GInvolvement of the nigrostriatal pathway in patients with idiopathic normal pressure hydrocephalus and parkinsonism. Neurology. 2025;104(5):e213352."},{"issue":"3","key":"bib7","series-title":"Can J Neurol Sci","first-page":"255","article-title":"Akinetic mutism and parkinsonism associated with obstructive hydrocephalus","volume":"12","author":"Berger","year":"1985","unstructured":"Berger LGauthier SLeblanc R.Akinetic mutism and parkinsonism associated with obstructive hydrocephalus. Can J Neurol Sci. 1985;12(3):255-258."},{"issue":"5","key":"bib8","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"341","article-title":"Akinetic mutism and parkinsonism after multiple shunt failure: case report and literature review","volume":"73","author":"Rebai","year":"2012","unstructured":"Rebai RMHouissa SMustapha MEAzzouni HAssaggaf S.Akinetic mutism and parkinsonism after multiple shunt failure: case report and literature review. J Neurol Surg A Cent Eur Neurosurg. 2012;73(5):341-346."},{"issue":"4","key":"bib11","series-title":"Children (Basel)","first-page":"644","article-title":"Cerebrospinal fluid protein concentrations in hydrocephalus","volume":"10","author":"Wilhelmy","year":"2023","unstructured":"Wilhelmy FKrause MSchob SCerebrospinal fluid protein concentrations in hydrocephalus. Children (Basel). 2023;10(4):644."},{"issue":"2","key":"bib9","series-title":"BMJ Open","first-page":"e025348","article-title":"Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre","volume":"9","author":"Brooks","year":"2019","unstructured":"Brooks JAMcCudden CBreiner ABourque PR.Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre. BMJ Open. 2019;9(2):e025348."},{"issue":"1","key":"bib1","series-title":"Semin Pediatr Neurol","first-page":"9","article-title":"A contemporary definition and classification of hydrocephalus","volume":"16","author":"Rekate","year":"2009","unstructured":"Rekate HL.A contemporary definition and classification of hydrocephalus. 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Children (Basel). 2023;10(4):644."},{"issue":"2","key":"bib9","series-title":"BMJ Open","first-page":"e025348","article-title":"Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre","volume":"9","author":"Brooks","year":"2019","unstructured":"Brooks JAMcCudden CBreiner ABourque PR.Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre. BMJ Open. 2019;9(2):e025348."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/4\/article-CASE25620.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/4\/article-CASE25620.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/4\/article-CASE25620.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:16Z","timestamp":1776094036000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/4\/article-CASE25620.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":20,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/case25620","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}