Introduction
Normal Pressure Hydrocephalus (NPH) is one of the causes of potentially
treatable dementia and presents with characteristic triad of gait
apraxia, cognitive impairment \RL and urinary incontinence.
Typically, it is associated with normal cerebrospinal fluid (CSF)
pressure and ventriculomegaly that is disproportionate to amount of
cerebral atrophy. Relkin et al. proposed the diagnostic criteria for
idiopathic NPH (iNPH) which was classified into probable, possible, and
unlikely categories (1).
There is a transient improvement in symptoms after a large-volume lumbar
tap or a short-term lumbar drain. In clinical point of view, this
technique is applied for prediction of patient who may respond to shunt
surgery. Furthermore, serial lumbar tap may be as a therapeutic option
for patients with NPH who are not good candidate for surgery.
CSF leak have been classified into traumatic and spontaneous (2).
Spontaneous (non traumatic) CSF leak is an uncommon, but well documented
presenting feature of a wide variety of intracranial pathologies
including hydrocephalus, tumor, increased intracranial pressure,
congenital anomalies or unknown causes (2, 3). Rarely, it may be a
presenting feature of NPH, which was reported previously in the context
of aqueductal stenosis (4, 5).
Here, we report an adult patient with NPH suffering from dementia and
gait disturbance who developed spontaneous CSF leakage from his nose
that led to dramatic improvement in gait and cognitive function. To our
best knowledge, it is the first report of spontaneous CSF rhinorrhea in
patients with NPH.