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Right putamen and claustrum infarction mimicking normal pressure hydrocephalus
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Right putamen and claustrum infarction mimicking normal pressure hydrocephalus
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Journal Article
Right putamen and claustrum infarction mimicking normal pressure hydrocephalus
2024
Overview
A woman in her 70s presented with approximately 2 years of sudden-onset gait and cognitive problems. She had been diagnosed with normal pressure hydrocephalus (NPH) and underwent ventriculoperitoneal shunt (VPS) placement 1 year prior. Before VPS placement, brain imaging showed ventriculomegaly and chronic infarction of the right putamen and claustrum. A lumbar drain trial resulted in modest improvement of gait dysfunction. She underwent VPS placement for suspected NPH, but her symptoms remained unchanged. Examination revealed mild cognitive impairment, left-sided and lower body predominant parkinsonism, as well as disproportionately prominent postural instability. Gait analysis showed increased gait variability, reduced velocity and shortened step length bilaterally. Motor and gait abnormalities did not change after administration of levodopa. Her symptoms have remained stable for up to 52 months since symptom onset. We postulate that the infarction affecting the right putamen and claustrum could have led to a higher-level gait disorder mimicking NPH.
Publisher
BMJ Publishing Group Ltd,BMJ Publishing Group LTD
Subject
/ Brain Infarction - complications
/ Brain Infarction - diagnostic imaging
/ Claustrum - diagnostic imaging
/ Cognitive Dysfunction - diagnostic imaging
/ Cognitive Dysfunction - etiology
/ Cognitive Dysfunction - surgery
/ Female
/ Gait
/ Gait Disorders, Neurologic - diagnostic imaging
/ Gait Disorders, Neurologic - etiology
/ Gait Disorders, Neurologic - surgery
/ Humans
/ Hydrocephalus, Normal Pressure - diagnosis
/ Hydrocephalus, Normal Pressure - diagnostic imaging
/ Hydrocephalus, Normal Pressure - surgery
/ Memory
/ Movement disorders (other than Parkinsons)
/ Posture
/ Putamen - diagnostic imaging
/ Stroke
