File(s) under permanent embargo
A case of shunt responsive tremor due to normal pressure hydrocephalus
journal contributionposted on 2014-12-15, 00:00 authored by Aron HillAron Hill, M W Cowey, D R Williams
Hydrocephalus refers to an abnormal accumulation of cerebral spinal fluid (CSF) within the brain resulting in enlarged ventricles and subsequent distortion of periventricular structures [ 1 ], while normal pressure hydrocephalus (NPH) is a specific form of communicating hydrocephalus where intra-ventricular CSF pressure remains in the normal range. As only a small disparity in pressure between the ventricles and surrounding subarachnoid space are needed to trigger absorption of interstitial fluid, ventricular enlargement still occurs in this condition [ 2 ], which is typically accompanied by symptoms of gait disturbance, urinary incontinence and cognitive impairment [ 3 ]. Although a number of movement disorders have been described in patients with hydrocephalus [ 4 ], the occurrence of tremor is a rare finding, which has consequently received very little attention in the literature and warrants further investigation. Here we present a case of an appendicular, predominantly lower-limb tremor occurring in a patient with concomitant idiopathic NPH, which demonstrated a marked reduction in amplitude following the insertion of a ventriculo-peritoneal shunt. The potential mechanisms underlying this clinical presentation are also discussed.