Abstract
Unusual presentations of disease states that have been well characterized over the years is key to ensuring the safety of patients and decreasing the overall mortality and morbidity. Patients often present with variations on classical conditions and it is key that providers be able to recognize these variations. This case study presents a 70-year-old female with a complex past medical history with variation of the classical Hakim-Adams triad of Normal Pressure Hydrocephalus. In this case, the patient’s symptoms included an increasingly depressed mood with some suicidal ideation, a potentially difficult to parse out gait disturbance, and urinary incontinence that had to be elucidated through conscious efforts. The patient was ultimately referred to neurosurgery for ventricular-peritoneal shunt placement. This case study includes a differential diagnosis with rationale for the different potential diagnoses, an in-depth look at the pathophysiology of Normal Pressure Hydrocephalus, the major treatment strategies, and highlights some clinical pearls for trainees and practicing providers.
Keywords
Normal Pressure Hydrocephalus, Ventricular-peritoneal shunt, Wet, Wacky, Wobbly, Depressed affect