P.123 Normal pressure hydrocephalus with associated tremor

Abstract

Background: Normal pressure hydrocephalus is a frequent cause of cognitive and functional impairment. Many symptoms are shared between Parkinson’s disease and normal pressure hydrocephalus. Only few studies examine extrapyramidal signs in NPH, and only one case report exists describing tremor improvement with shunting. Methods: We performed a retrospective chart review of our NPH database. We selected patients who had both NPH and question of Parkinsonism due to tremor. Results: Six patients with both NPH diagnosis and tremor were identified. Three patients were treated for Parkinson’s disease and followed by neurology. After shunting, all three improved and attempt was made to wean medications, which led to functional decline. The other three patients improved with shunting and after titration of the shunt had resolution of tremor. Conclusions: We provide evidence that NPH can result in tremor, treatable by shunting. We also emphasize that those patients do exist who have both diseases. This likely exists along a continuum. Careful consideration of NPH should be undertaken in those patients with suspected Parkinson’s disease and imaging findings reminiscent of NPH.