A case of lacunar stroke in a patient with possible normal pressure hydrocephalus (NPH)

Abstract

Background: Normal pressure hydrocephalus (NPH) is a condition seen in the elderly, characterized by
gait disturbances, urinary incontinence, and cognitive impairment. However, sudden onset neurological
deficits suggest a vascular event rather than NPH.
Methodology: We report a case of a 65-year-old male who presented with sudden onset gait difficulty
and speech impairment, initially suspected to be idiopathic NPH. The diagnostic process and
management strategies are discussed.
Results: The patient's symptoms, including insidious gait difficulties, speech impairment, and memory
loss, led to a suspected diagnosis of NPH. However, the sudden improvement of neurological deficits
indicated a vascular cause. Computed Tomography (CT) imaging identified supporting evidence of a
lacunar stroke, leading to a revised diagnosis.
Conclusion: This case highlights the importance of considering vascular events in the differential
diagnosis of NPH, especially when sudden neurological deficits improve rapidly. Early identification and
differentiation between NPH and vascular events are crucial for appropriate management, particularly in
low-resource settings.