Psychiatria pre prax 2/2022

Normal pressure hydrocephalus in patient with schizophrenia

Normal pressure hydrocephalus is a possible reversible cause of dementia, gait disorders and urinary incontinence. These symptoms create a characteristic Hakim-Adams triad in clinical picture. Due to the possible reversible nature of the changes, its early detection and surgical treatment are crucial for the patient›s prognosis. Comorbidity between schizophrenia and normal pressure hydrocephalus is more common than initially thought and occurs mainly in the elderly. Comorbidity with schizophrenia may delay the treatment of normotensive hydrocephalus. This diagnosis can go unnoticed for several reasons. One is the attribution of cognitive impairment to core cognitive symptoms of schizophrenia. Long-term antipsychotic treatment is also a complicating factor. This therapy often leads to the development of extrapyramidal symptoms and gait disorders. Gait and movement disorders in normal pressure hydrocephalus may be incorrectly attributed to the side effects of long-term antipsychotic treatment. Antipsychotics, especially those with anticholinergic effects, may also alter the urge to urinate or urinary incontinence. Uncertainties may also be present during magnetic resonance imaging. In a large proportion of patients with schizophrenia, magnetic resonance imaging describes ventriculomegaly and its differentiation from normal pressure hydrocephalus requires a more substantial evaluation of the findings. Another problem with comorbidity of schizophrenia and normal pressure hydrocephalus is the restrained attitude of the surgeon to shunt surgery. However, this operation is crucial for the patient›s prognosis and it turns out that comorbidity with schizophrenia does not affect the therapeutic outcome. In addition to comorbidity with normal pressure hydrocephalus and psychotic disorders, psychotic symptoms may also occur as a result of normal pressure hydrocephalus itself. Early differential diagnosis and determination of secondary causes of psychotic symptoms is equally crucial, as causal treatment is available for normal pressure hydrocephalus. The presented case report documents the process of diagnosis and the course of normal pressure hydrocephalus in patient with schizophrenia spectrum disorder. The suspicion of normal pressure hydrocephalus was aroused by a significant deterioration of cognitive functions and the presence of new onset gait disorder, not attributable to antipsychotic treatment. The diagnosis was confirmed by magnetic resonance imaging. The realization of the surgical procedure was complicated by the finding of a lung tumor within the preoperative examination.

Keywords: comorbidity, dementia, gait disorder, normal pressure hydrocephalus, schizophrenia