Normal Pressure Hydrocephalus Presenting as Othello Syndrome: Case Presentation and Review of the Literature

Abstract

Normal pressure hydrocephalus (NPH), an obstruction in the normal flow of CSF through the subarachnoid space, typically presents with a classic “triad” of cognitive impairment, a gait disturbance, and urinary incontinence (1). The etiology of NPH includes subarachnoid spaceoccupying lesion or hemorrhage, chronic meningoencephalitis, changes following acute bacterial meningitis or spinal anesthesia, and carcinomatosis of the meninges (2). Usually, the underlying cause cannot be identified. Idiopathic NPH is clinically diagnosed in most patients during the sixth or seventh decade of life (3). The cognitive impairment in NPH most often manifests as subcortical dementia, though psychiatric and mood symptoms, most often depression, have been described. Most observations of psychiatric sequelae of NPH have been limited to case reports and have included frontal lobe symptoms such as apathy and akinetic mutism, as well as reports of mania, aggression, mood cycling, and psychosis (4–8). In this article, we report a case of NPH presenting as paranoid psychosis with delusional jealousy, otherwise known as the “Othello syndrome.” Case Presentation