Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

An improved case of bedridden mental impairment with normal pressure hydrocephalus associated with acoustic neurinoma after tumor resection

Seiichiro Sugimoto, M.D.1), Akiko Sugimoto, M.D.3), Kazuko Saita, M.D.1), Masahiko Kishi, M.D.4), Keiichi Shioya, M.D.1) and Toshinobu Higa, M.D.2)

1)Department of Neurology, National Hospital Organization Miyazaki Higashi Hospital
2)Internal Medicine, National Hospital Organization Miyazaki Higashi Hospital
3)Department of Neurology, Junwakai Memorial Hospital
4)Department of Neurology, Toho University Sakura Medical Center

A 67-year-old woman developed gait disturbance, dysarthria, cognitive impairment and incontinence at age 65, and became bedridden. She showed mutism, stupor and lower limb spasticity. Cranial CT and MRI revealed marked ventricular enlargement and a cerebellopontine angle tumor. CSF study showed normal pressure (125 mmH2O) and elevated protein (143 mg/dl). Radionuclide cisternography showed redistribution of radionuclide to the ventricles and intraventricular residual radionuclide after 72 hours, which allowed a diagnosis of normal pressure hydrocephalus. After removal of the tumor, ventricle size and CSF protein decreased, and the symptoms of cognitive impairment and motor dysfunction resolved. Histological examination showed acoustic neurinoma. Over the half of hydrocephalus following acoustic neurinoma shows a tendency to improve by surgical resection of the tumor. Neurologists who see cognitively impaired spastic bedridden patients should not overlook this pathology.
Full Text of this Article in Japanese PDF (527K)

(CLINICA NEUROL, 48: 575|578, 2008)
key words: normal pressure hydrocephalus, cognitive impairment, acoustic neurinoma, elevated CSF protein, radionuclide cisternography

(Received: 7-Jun-07)