Abstract
A 72-year-old male science teacher with normal pressure hydrocephalus presented 1 year after ventriculoperitoneal (VP) shunt placement with neck pain, behavioral changes, and nonamnestic cognitive decline. Six months prior, his shunt was adjusted from 4 to 3. Montreal Cognitive Assessment was 21/30 with dysexecutive predominance. EEG was unremarkable. CSF Alzheimer disease biomarkers were borderline. MRI (Figure 1) found overshunting. After shunt adjustments (3–4), his cognitive and behavioral symptoms resolved. Repeat Montreal Cognitive Assessment after 4 months was 29/30 with sustained remission after 1 year. Intracranial hypotension, whether from VP shunting or spontaneous CSF leak,1,2 may cause reversible dysexecutive cognitive impairment.
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