Right putamen and claustrum infarction mimicking normal pressure hydrocephalus.
Natalia ChungaKyra CurtisColleen B TomcikKarlo J LizarragaPublished in: BMJ case reports (2024)
A woman in her 70s presented with approximately 2 years of sudden-onset gait and cognitive problems. She had been diagnosed with normal pressure hydrocephalus (NPH) and underwent ventriculoperitoneal shunt (VPS) placement 1 year prior. Before VPS placement, brain imaging showed ventriculomegaly and chronic infarction of the right putamen and claustrum. A lumbar drain trial resulted in modest improvement of gait dysfunction. She underwent VPS placement for suspected NPH, but her symptoms remained unchanged. Examination revealed mild cognitive impairment, left-sided and lower body predominant parkinsonism, as well as disproportionately prominent postural instability. Gait analysis showed increased gait variability, reduced velocity and shortened step length bilaterally. Motor and gait abnormalities did not change after administration of levodopa. Her symptoms have remained stable for up to 52 months since symptom onset. We postulate that the infarction affecting the right putamen and claustrum could have led to a higher-level gait disorder mimicking NPH.
Keyphrases
- mild cognitive impairment
- cerebral palsy
- cognitive decline
- clinical trial
- parkinson disease
- subarachnoid hemorrhage
- mental health
- high resolution
- randomized controlled trial
- ultrasound guided
- study protocol
- cerebrospinal fluid
- white matter
- pulmonary embolism
- minimally invasive
- depressive symptoms
- sleep quality
- pulmonary hypertension
- physical activity
- pulmonary artery
- pulmonary arterial hypertension
- phase iii
- blood brain barrier