A case of normal pressure hydrocephalus with peripheral vestibular disorder-like findings.

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1 A case of normal pressure hydrocephalus with peripheral vestibular disorder-like findings. Yuzuru Sainoo 1)2), Hidetaka Kumagami 3), Haruo Takahashi 1) 1) Goto Chuoh Hospital, Otorhinolaryngology 2) Department of Otolaryngology - Head and Neck Surgery. Nagasaki University Graduate School of Biomedical Sciences 3) The Japanese Red Cross Nagasaki Genbaku Hospital We hereby report on our experience regarding a case of rotatory vertigo exhibiting vestibular disorder-like findings accompanying normal pressure hydrocephalus (NPH). The case pertains to a 60-year-old man. Gait disturbance, dysuria, and so on, appeared from around 2007, and he was diagnosed as having NPH by the Department of Neurology of our hospital?. Rotatory vertigo suddenly appeared in October 2011, and he was admitted to the Department of Neurology and subsequently referred to our department on the 2 nd sick day. Third degree of horizontal rotatory nystagmus to the left was observed, with no difference between the left and right observed upon a hearing test, and although he was observed with an increased threshold in the high sound area appropriate to his age, no other neurologic symptoms were observed. An equilibrium test was carried out at a later date under the suspicion of right vestibular neuronitis, however, no decline in semicircular canal function was observed upon caloric testing, with no difference between the left and right observed as well upon vestibule-ocular reflex (VOR), and so a follow-up was carried out with a diagnosis of vertebrobasilar insufficiency. The symptoms subsequently rapidly improved, however, nystagmus to the left at III appeared again one week later, with the same nystagmus appearing again two months later. Lightheadedness was prolonged when rotatory vertigo attacks were not observed and so the patient consulted the Department of Neurology and underwent a tap test taking into consideration his dizziness caused by NPH, as a result of which his dizziness rapidly disappeared compared to the day prior, along with the other symptoms including improved gait disturbance and dysuria, which all continued to improve further. Subsequently, all dizziness disappeared after undergoing an endoscopic third ventriculostomy. Key words: NPH, vertigo, endoscopic third ventriculostomy ( 528 )

2 normal pressure hydrocephalus, NPH 200 mmh O NPH NPH MRI Timed up & go test Trail making test TMT MRI C3 C db 15 db Romberg visual suppression CT MRI ATP NPH NPH 110 mmh O 30 ml 0 mmh O 1/mm 43 mg/dl TMT A TMT B Timed up & go test TMT A 28 TMT B Timed up & go test MRI flow void ( 529 )

3 NPH square wave jerks NPH Yaw PPRF MRI Barlas MRI Hopf Su retrospective MRI ( 530 )

4 unilateral gaze nystagmusbilateral gaze nystagmus Su NPH NPH NPH MRI NPH Malm J, Eklund A: Idiopathic normal pressure hydrocephalus. Pract Neurol 6: 14 27, 2006 Krauss JK, Halve B: Normal pressure hydrocephalus: survey on contemporary diagnostic algorithms and therapeutic decision making in clinical practice. Acta Neurochir(Wien)146: , 2004 Vanneste JA: Diagnosis and management o normal pressure hydrocephalus. J Neurol 247: 5 14, 2000 Equilibrium Res 68: 74 80, 2009 Brandt T, Dieterich M: Vestibular falls. J Vestib Res 3: 3 14, 1993 Dieterich M: The topographic diagnosis of acquired nystagmus in brainstem disorders. Strabismus 10: , 2002 Equilibrium Res 66: , 2007 Barlas O, Gökay H, Turantan MI, et al.: Adult aqueductal stenosis presenting with fluctuating hearing loss and vertigo. Report of two cases. J Neurosurg 59: , 1983 Hopf HC.: Vertigo and masseter paresis. A new local brainstem syndrome probably of vascular origin. J Neurol 235: 42 45, 1987 ( 531 )

5 Su CH, Young YH: Disorders affecting the fourth ventricle: etiology and clinical correlates. Otol Neurotol 32: , 2011 Alver I, Abuzayed B, Kafadar AM, et al: Primary Fourth Ventricular Meningioma: Case Report and Review of the Literature. Turkish Neurosurgery 21: , 2011 Equilibrium Res 50 (Suppl 7): 38 42, 1991 ( 532 )

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