Normal pressure hydrocephalus

Although the prevalence of Normal-pressure hydrocephalus (NPH) remains imprecise and is calculated to be 1.30% for those aged ≥ 65 years, a severe problem of underdiagnosis seems to exist 1).

A case of normal pressure hydrocephalus (NPH) 2 months after acute COVID19 infection, in a patient without other risk factors.

A 45-year-old male patient presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was progressive improvement after shunting, with complete resolution of symptoms.

Other infections such as syphilis, cryptococcosis and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association 2)

Martín-Láez R, Caballero-Arzapalo H, López-Menéndez LÁ, Arango-Lasprilla JC, Vázquez-Barquero A (2015) Epidemiology of idiopathic normal pressure hydrocephalus: a systematic review of the literature. World Neurosurgery 84:2002–2009. https://doi. org/10.1016/j.wneu.2015.07.005
Vasconcelos TMF, Nóbrega PR, Ferreira GM, de Souza MLP, Vanderlei AS, de Castro JDV, Braga-Neto P, Sobreira-Neto MA. Normal pressure hydrocephalus associated with COVID-19 infection: a case report. BMC Infect Dis. 2022 Mar 3;22(1):216. doi: 10.1186/s12879-022-07184-x. PMID: 35241017; PMCID: PMC8892823.
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