Cerebral bleed after shunt for normal pressure hydrocephalus with cerebral amyloid angiopathy: Coincidence or consequence?

The triad of gait impairment, cognitive decline, and urinary incontinence in the setting of normal CSF pressure has long been described, yet our ability to predict who will experience a prolonged, meaningful response to ventriculoperitoneal (VP) shunting remains limited.1–4 Unfortunately, the procedure is associated with major risk, and improvements following shunting are not guaranteed and are often short-lived. Assessing the harm to benefit ratio can be problematic.2,4 It is imperative not only to identify those likely to respond to shunting but also to identify those with a higher risk of adverse events or those unlikely to respond. Here we report a case of right frontal lobe hemorrhage following VP shunt placement in a patient with preoperative MRI evidence of cerebral amyloid angiopathy (CAA).