In general, idiopathic normal pressure hydrocephalus (iNPH) patients do not have Parkinson’s disease.

However, some cases of iNPH accompanying Parkinson’s have recently been reported, requiring combined treatments of the two diseases, the Seoul National University Bundang Hospital (SNUBH) said Tuesday.

Professor Park Young-ho of the Department of Neurology at Seoul National University Bundang Hospital (SNUBH) and his team have reported cases of idiopathic normal-pressure hydrocephalus accompanied by Parkinson’s.
Professor Park Young-ho of the Department of Neurology at Seoul National University Bundang Hospital (SNUBH) and his team have reported cases of idiopathic normal-pressure hydrocephalus accompanied by Parkinson’s.

Hydrocephalus is a somewhat unfamiliar disease. Major symptoms include difficulty in walking and urinating and memory decline. Hence, this is easily confused with Parkinson’s disease. However, these symptoms can be improved through surgical treatment, according to the hospital.

Humans’ brain floats on the cerebrospinal fluid inside the space of the strong skull. This cerebrospinal fluid prevents the brain from external shock and being squashed by skulls. Also, the fluid delivers neurohormone to the brain, and it also gets rid of wastes.

It results from the accumulation of cerebrospinal within the brain, unable to maintain the optimal amount of 120-150 ml. Normal-pressure hydrocephalus occurs even when the pressure of cerebrospinal fluid remains normal. Too much accumulation of cerebrospinal fluid can pressurize the brain tissues, resulting in symptoms like gait disturbance, urinary incontinence, and cognitive impairment.

It is easily confused with Parkinson’s disease.

These are the MRI images of a healthy brain (left) and the brain of an NPH patient (right). The NPH patient’s brain shows an expanded cerebral ventricle due to accumulated cerebrospinal fluids.
These are the MRI images of a healthy brain (left) and the brain of an NPH patient (right). The NPH patient’s brain shows an expanded cerebral ventricle due to accumulated cerebrospinal fluids.

In normal-pressure hydrocephalus (NPH), symptoms can be improved by removing the excessive accumulation of cerebrospinal fluid that relieves the brain tissues from pressure. This is possible through a simple procedure of extracting the fluid through a needle injected in the space between the lumbar.

However, the effects of the drainage cannot last long enough since the cerebrospinal fluid is continuously produced inside the brain. Thus, if the symptoms are relieved after the procedure, NPH is treated with a shunt operation that drains the cerebrospinal fluid through the abdominal cavity.

In Parkinson’s, medicinal therapy is the main treatment, but in NPH, medicinal therapy does not have much effect.

These are the PET scan comparison of a healthy brain (left) and the brain of a Parkinson’s patient (right). The brain of the Parkinson’s patient shows a weak response in the basal nuclear site.
These are the PET scan comparison of a healthy brain (left) and the brain of a Parkinson’s patient (right). The brain of the Parkinson’s patient shows a weak response in the basal nuclear site.

Professor Park Young-ho of the Neurology Department at SNUBH said his patient showed big improvement in walking after cerebrospinal fluid drainage. Hence, the patient was diagnosed with NPH.

However, REM sleep behavior disorder and slow movement were noticeable. Also, in positron emission tomography (PET) imaging of dopamine transporter (DAT) scans, the results were suspicious of Parkinson’s disease. REM sleep behavior disorder refers to movement in sleep due to abnormal strain of the muscle.

“NPH is comparatively common in the elderly. It is found in two in 100 people aged 70 or more,” Professor Park said. “In the case of the patient in question, he was diagnosed with NPH but showed severe symptoms of REM sleep behavior disorder and slow movement. Through PET screening, traits of Parkinson’s were found. Hence, shunt operation was performed in addition to the prescription of Parkinson’s medication.”

Symptoms of NPH can be relieved with surgical treatment. However, when symptoms of loss of memory, difficulty in walking, or urination are found in old age, a check-up is necessary to find out if it is NPH, he added.

“In particular, NPH patients with symptoms of REM sleep behavior disorder or slow movement must suspect NPH accompanied by Parkinson’s disease and get proper treatment.”

The research result was published in the July edition of the American Academy of Neurology’s journal, Neurology.

Copyright © KBR Unauthorized reproduction, redistribution prohibited