Watanabe Shinya, Shibata Yasushi, Baba Kosuke, Kuriyama Yuhei, Ishikawa Eiichi
Department of Neurosurgery, Mito Kyodo General Hospital, Tsukuba University Hospital Mito Area Medical Education Center, Mito 310-0015, Japan.
Institute of Medicine, University of Tsukuba, Tsukuba 305-8576, Japan.
Neurol Int. 2025 May 30;17(6):86. doi: 10.3390/neurolint17060086.
Idiopathic normal-pressure hydrocephalus (iNPH) is a potentially reversible neurological disorder characterized by gait disturbance, cognitive impairment, and urinary incontinence. Its pathophysiology involves impaired cerebrospinal fluid (CSF) absorption, and recent research has highlighted the role of the glymphatic and meningeal lymphatic systems in this process. However, the factors that trigger the clinical manifestations of iNPH in subclinical cases remain poorly understood. : Herein, we report two rare cases of iNPH in which clinical symptoms only became apparent following systemic infections. An 82-year-old man presented with transient neurological deficits during a course of sepsis caused by . Neuroimaging revealed periventricular changes and mild ventricular enlargement. Shunting and a tap test led to significant improvements to both his gait and cognition. An 80-year-old man with a history of progressive gait disturbance and cognitive decline developed worsening urinary incontinence and acute cerebral infarction caused by bacteremia. Magnetic resonance imaging revealed a ventriculomegaly with features of disproportionally enlarged subarachnoid space hydrocephalus and a corona radiata infarct. Clinical improvement was achieved after a ventriculoperitoneal shunt was placed. : Our two present cases suggest that systemic inflammatory states may act as catalysts for the manifestation of iNPH in patients with predisposing cerebral ischemia or subclinical abnormalities in CSF flow, highlighting the need for higher clinical awareness of iNPH in older patients who present with neurological deterioration during systemic infections. Early diagnosis and timely shunting after appropriate infection control may facilitate significant functional recovery in such patients.
特发性正常压力脑积水(iNPH)是一种潜在可逆的神经系统疾病,其特征为步态障碍、认知障碍和尿失禁。其病理生理学涉及脑脊液(CSF)吸收受损,最近的研究强调了胶质淋巴系统和脑膜淋巴系统在这一过程中的作用。然而,在亚临床病例中触发iNPH临床表现的因素仍知之甚少。在此,我们报告两例罕见的iNPH病例,其临床症状仅在全身感染后才变得明显。一名82岁男性在由……引起的败血症病程中出现短暂神经功能缺损。神经影像学显示脑室周围改变和轻度脑室扩大。分流和腰穿试验使他的步态和认知能力都有显著改善。一名有进行性步态障碍和认知衰退病史的80岁男性因……菌血症出现尿失禁加重和急性脑梗死。磁共振成像显示脑室扩大,具有蛛网膜下腔脑积水不成比例扩大和放射冠梗死的特征。放置脑室腹腔分流术后临床症状改善。我们目前的两例病例表明,全身炎症状态可能是易患脑缺血或脑脊液流动存在亚临床异常的患者中iNPH表现的催化剂,这突出了对于在全身感染期间出现神经功能恶化的老年患者提高对iNPH临床认识的必要性。在适当的感染控制后早期诊断并及时分流可能有助于此类患者显著的功能恢复。