From Parkinsonism to Hydrocephalus: Unraveling a Complex Diagnosis

Authors

Mukesh Kumar, Department of Neurology, Reading Hospital - Tower Health, West Reading, PAFollow
Simranpreet Singh, Department of Neurology, Reading Hospital - Tower Health, West Reading, PAFollow
FNU Shivangi, Department of Neurology, Reading Hospital - Tower Health, West Reading, PAFollow
Spandana Chittajallu, Department of Neurology, Reading Hospital - Tower Health, West Reading, PAFollow
Ahmad Alsibai

Document Type

Abstract

Publication Date

4-8-2025

Abstract

Objective: To report a case of obstructive hydrocephalus masquerading as Parkinson's disease (PD). Background: Parkinson's disease affects over 1% of those over 60 and can be either idiopathic or secondary, impacting treatment and prognosis. Its overlapping features with obstructive hydrocephalus complicate diagnosis, highlighting the importance of imaging in cases with ambiguous presentations to improve outcomes. Design/Methods: Case report Results: A 62-year-old male who worked at lead battery company, with no significant history, presented to neurology clinic for bilateral leg weakness and heaviness and difficulty initiating walk causing falls for past 6 months. Wife reported memory issues, but patient was independent with activities of daily living. Initial exam showed bradykinesia, masked facies, diffuse hyperreflexia, reduced arm swing, and en bloc turning with no cogwheel rigidity. MoCA score was 21/30 with points lost on visuospatial, abstraction, and delayed recall. He met criteria for Parkinson's disease and was started on Sinemet trial. Labs showed RPR, TSH, Vitamin B12, MMA, vitamin B1, folate, copper, and lead within normal limits. MRI Brain showed severe stenosis of inferior cerebral aqueduct and dilation of proximal ventricular system with transependymal flow. MRI Cervical spine done for diffuse hyperreflexia showed mild central spinal stenosis at level of C4-C5. He continued to have falls and underwent ventriculoperitoneal shunt placement. Subsequent CT head showed substantially decreased hydrocephalus. Patient's gait improved significantly with persistent mildly reduced arm swing and en bloc turning and his MoCA improved to 27/30. Sinemet was gradually tapered and eventually discontinued. Conclusions: Parkinsonism can be secondary to hydrocephalus, complicating differentiation from idiopathic Parkinson's disease. Ourpatient had inferior aqueductal stenosis and periaqueductal edema, affecting medial substantia nigra projections andmimicking Parkinson's symptoms. Despite meeting UKPDSBB criteria with bradykinesia and postural instability, unresponsiveness to dopaminergic treatment and falls within three years raises suspicion for an alternate pathology.

Publication Title

Neurology

Volume

104

Issue

7 Supplement 1

First Page

P3-5.032

Comments

Annual Meeting of the American Academy of Neurology, AAN 2025 held 2025-04-05 to 2025-04-09 in San Diego, CA, USA.

Recommended Citation

Kumar, M., Singh, S., Shivangi, F., Chittajallu, S., & Alsibai, A. (2025). From Parkinsonism to Hydrocephalus: Unraveling a Complex Diagnosis. Neurology, 104 (7 Supplement 1), P3-5.032. https://doi.org/https://doi.org/10.1212/WNL.0000000000212223