Normal pressure hydrocephalus in a patient with alcohol dependence: A case report

Normal-pressure hydrocephalus (NPH) is characterized by a classic triad of symptoms namely urinary incontinence, dementia, and gait disturbances. It may present initially with psychiatric symptoms like depression, perceptual disturbances, anxiety, etc. This case report describes a 58-year-old male patient with alcohol dependence who presented with complaints of urinary incontinence, forgetfulness, imbalance while walking and standing, fearfulness, hearing of unreal voices along with sleep appetite impairment since 3-4 months. He was consuming alcohol since the last 20 years.  On examination, he was conscious, oriented to time and place. He had mild tremors. Vitals were stable. Mental status examination revealed patient was shabby, ill kempt, uncooperative, irritable, along with delusion of persecution and auditory hallucinations. Insight about his illness was impaired. MMSE score was 18. MRI suggested a disproportionate dilatation of the ventricular system as compared to the basal cisterns, sylvian fissures and cortical sulci. Careful examination of patients presenting with above symptoms is necessary for proper management of patients with NPH. Keywords: Normal pressure hydrocephalus, Psychosis, Psychiatric symptoms, Depression, Perceptual disturbances, Anxiety.