Neuropsychiatric manifestations in patient with normal pressure hydrocephalus improved with therapeutic lumbar tapping

Kumari Padma, Chandini ., Siddharth Shetty A., safeekh A. T., Raghavendra B. S.


Normal pressure hydrocephalus is a communicating hydrocephalus without evident obstruction of the normal pathway of CSF flow. Normal-pressure hydrocephalus is a common cause of reversible dementia and it can also present with various psychiatric symptoms. A 76-year old man was brought to psychiatry OPD with history suggestive of decreased need for sleep for 8 days, disinhibited behaviour, increased libido, increased activity and increased talk for 4 days. On examination patient was noticed to be having increased psychomotor activity with increased talk, mood reported to be happy with elated affect, no content or perceptual disturbances were elicited. Cognitive functions were within normal limits. Personal and social judgement was impaired with grade 0 insight. General physical and systematic examinations were within normal limits. MRI reports showed ventricular enlargement suggestive of normal pressure hydrocephalus. Patient underwent diagnostic and therapeutic lumbar tapping. There was significant improvement in patient’s behavioural symptoms following therapeutic lumbar tapping. Therapeutic lumbar tapping in this case of normal pressure hydrocephalus was effective in the management of manic symptoms. Early identification of organic cause in late onset psychiatric disorders is necessary. Prompt intervention of the organic cause was effective in the management of manic symptoms.


Mania, Normal pressure hydrocephalus, Therapeutic tapping

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Bradley WG. Normal pressure hydrocephalous: new concept on etiology and diagnosis. Am J Neuroradiol. 2000;21(9):1586-90.

Alao AO, Naprawa SA. Psychiatric complications of hydrocephalous. Int J Psychiatry Med. 2001;31(3):337-40.

Kito Y, Kazui H, Kubo Y, Yoshida T, Takaya M, Wada T, et al. Neuropsychiatric symptoms in patient with idiopathic normal pressure hydrocephalous. Behav Neurol. 2009;21(3):165-74.

Pinner G, Johnson H, Bouman WP, Isaacs J. Psychiatric manifestations of normal-pressure hydrocephalus: a short review and unusual case. Int Psychogeriat. 1997;9(4):465-70.

Rice E, Gendelman S. Psychiatric aspects of normal pressure hydrocephalus. JAMA. 1973;223(4):409-12.

Kwentus JA, Hart RP. Normal pressure Hydrocephalus presenting as Mania. J Nervous Mental Dis.1987;175(8):500-2.

Malm J, Graff-Radford NR, Ishikawa M, Kristensen B, Leinonen V, Mori E, et al. Influence of comorbidities in idiopathic normal pressure hydrocephalus-research and clinical care. A report of the ISHCSF task force on comorbidities in INPH. Fluids Barriers CNS. 2013;10(1):22.

Casmiro M, d'Alessandro R, Cacciatore FM, Daidone R, Calbucci F, Lugaresi E. Risk factors for the syndrome of ventricular enlargement with gait apraxia (idiopathic normal pressure hydrocephalus): a case-control study. J Neurol Neurosurg Psychiat. 1989;52(7):847-52.

Messert B, Baker NH. Syndrome of progressive spastic ataxia and apraxia associated with occult hydrocephalus. Neurol. 1966;16(5):440.

Estanol BV. Gait apraxia in communicating hydrocephalus. J Neurol Neurosurg Psychiat. 1981;44(4):305-8.

Ahlberg J, Norlen L, Blomstrand C, Wikkelsö C. Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar puncture. J Neurol Neurosurg Psychiat. 1988;51(1):105-8.

Tsuang MT, Tidball JS, Geller D. ECT in a depressed patient with shunt in place for normal pressure hydrocephalus. Am J Psychiatry. 1979;136(9):1205-6.