Abstract：
OBJECTIVE: Idiopathic normal pressure hydrocephalous (iNPH) is a potentially reversible syndrome characterized by ventriculomegaly. Parkinsonism is an often-overlooked clinical feature of iNPH. Mostile et al. (2022) argued that the diagnostic iNPH \"triad\" should be reconsidered as a \"tetrad\" including parkinsonism. This case will discuss iNPH presenting with parkinsonism. Patient is an 81-year-old male with a history of iNPH with Hakim\'s triad. His medical history includes hyperlipidemia, hypertension, deep vein thrombosis, benign prostatic hyperplasia, total knee replacement, and chronic depression. Presenting concerns were continued cognitive and gait impairments.
METHODS: Patient was referred from his physiatrist for evaluation of his cognitive functioning and assistance with discharge planning in an acute inpatient rehabilitation hospital. Patient was neuropsychologically evaluated to clarify the etiology of his cognitive presentation.
RESULTS: Patient\'s cognitive profile was impaired in areas of attention, executive functioning, processing speed, visuoperception, and displayed a subcortical memory profile. Patient had intact functioning in areas of oral reading, naming, and working memory. Motor examination was evident for apraxia, task-specific tremor, and micrographia.
CONCLUSIONS: This case report provides additive findings for common presentation of iNPH including parkinsonism presenting with comorbid psychiatric and medical confounders, highlighting the need for further research on neuropsychological profile of iNPH post shunt procedure. It also accentuates the need to accept parkinsonism as one of the common presentations of iNPH. Akinesia has been reported in nearly 70% of iNPH cases (Krauss et al, 1997), with bradykinesia and postural instability being the main parkinsonian features. Asymmetry and resting tremor were seen to be uncommon (Molde et al., 2017).
METHODS: Patient was referred from his physiatrist for evaluation of his cognitive functioning and assistance with discharge planning in an acute inpatient rehabilitation hospital. Patient was neuropsychologically evaluated to clarify the etiology of his cognitive presentation.
RESULTS: Patient\'s cognitive profile was impaired in areas of attention, executive functioning, processing speed, visuoperception, and displayed a subcortical memory profile. Patient had intact functioning in areas of oral reading, naming, and working memory. Motor examination was evident for apraxia, task-specific tremor, and micrographia.
CONCLUSIONS: This case report provides additive findings for common presentation of iNPH including parkinsonism presenting with comorbid psychiatric and medical confounders, highlighting the need for further research on neuropsychological profile of iNPH post shunt procedure. It also accentuates the need to accept parkinsonism as one of the common presentations of iNPH. Akinesia has been reported in nearly 70% of iNPH cases (Krauss et al, 1997), with bradykinesia and postural instability being the main parkinsonian features. Asymmetry and resting tremor were seen to be uncommon (Molde et al., 2017).
摘要：
目的：特发性正常压力脑积水（iNPH）是一种潜在的可逆性综合征，其特征是脑室增宽。帕金森病是iNPH经常被忽视的临床特征。Mostile等人。（2022）认为，诊断iNPH“三合会”应重新考虑为“四合会”，包括帕金森病。这个案例将讨论iNPH表现为帕金森病。患者为一名81岁男性，有iNPH伴Hakim三联征病史。他的病史包括高脂血症，高血压,深静脉血栓形成,良性前列腺增生,全膝关节置换术,慢性抑郁症。表现出的担忧是持续的认知和步态障碍。
方法：患者在一家急性住院康复医院接受物理医师的转诊，以评估其认知功能并协助制定出院计划。对患者进行神经心理学评估，以阐明其认知表现的病因。
结果：患者的认知状况在注意区域受损，执行功能，处理速度,视觉感知，并显示了皮质下的记忆特征.患者在口腔阅读区域有完整的功能，命名,和工作记忆。运动检查有明显的失用症，特定任务的震颤，和micrographia.
结论：本病例报告为iNPH的常见表现提供了附加的发现，包括伴有精神病和医学混杂因素的帕金森病，强调需要进一步研究分流术后iNPH的神经心理学特征。它还强调了接受帕金森病作为iNPH常见表现之一的必要性。在近70%的iNPH病例中已经报道了运动障碍(Krauss等人，1997),运动迟缓和姿势不稳定是帕金森病的主要特征。不对称和静息性震颤被认为是罕见的(Molde等人。,2017)。
方法：患者在一家急性住院康复医院接受物理医师的转诊，以评估其认知功能并协助制定出院计划。对患者进行神经心理学评估，以阐明其认知表现的病因。
结果：患者的认知状况在注意区域受损，执行功能，处理速度,视觉感知，并显示了皮质下的记忆特征.患者在口腔阅读区域有完整的功能，命名,和工作记忆。运动检查有明显的失用症，特定任务的震颤，和micrographia.
结论：本病例报告为iNPH的常见表现提供了附加的发现，包括伴有精神病和医学混杂因素的帕金森病，强调需要进一步研究分流术后iNPH的神经心理学特征。它还强调了接受帕金森病作为iNPH常见表现之一的必要性。在近70%的iNPH病例中已经报道了运动障碍(Krauss等人，1997),运动迟缓和姿势不稳定是帕金森病的主要特征。不对称和静息性震颤被认为是罕见的(Molde等人。,2017)。
