Clinical and Radiological Features of Possible Normal Pressure Hydrocephalus in a Patient with Multiple Sclerosis

Abstract

Normal pressure hydrocephalus (NPH) is potentially treatable form of dementia, which along with gait disturbance and impaired urinary control compose a clinical picture of the Hakim-Adams syndrome. In advanced age it could be challenging to distinguish the disease from other form of dementias or brain atrophy. From another prospective, other brain conditions could have a number of similar symptoms that could make it even harder to raise a suspicion of NPH. In this article we describe a clinical picture, neurological examination data, neuroimaging and clinical analysis of blood and cerebrospinal fluid (CSF) of the patient with confirmed multiple sclerosis (MS) and symptoms falling under Hakim-Adams triad criteria. On the other hand, pronounced cortical atrophy and patient`s cognitive decline, could be a consequence of prolonged disease, absence of disease-modifying treatment and poor compliance of the patient. Challenges in management of the patient were not only limited by the duration of the multiple sclerosis, but also a number of comorbidities in the history of the disease and not straightforward data after performing the tap test. Thorough review of a patient with multiple sclerosis with clinical manifestations corresponding to Hakim's triad, and with ventriculomegaly on CT/MRI, should be performed as the comorbidity of MS and NPH has to be excluded.