Annals of Indian Academy of Neurology
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CASE REPORT
Year : 2016  |  Volume : 19  |  Issue : 2  |  Page : 245-248

Unusual idiopathic normal pressure hydrocephalus patient with marked asymmetric and upper body parkinsonism


1 Department of Neurology, School of Medicine; Brain Science & Engineering Institute, Kyungpook National University, Daegu, Korea
2 Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea

Correspondence Address:
Ho-Won Lee
Department of Neurology, School of Medicine, Brain Science & Engineering Institute, Kyungpook National University, 50 Samdeok-dong 2-ga, Jung-gu, Daegu - 700 721
Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.160057

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Asymmetry of parkinsonian symptoms is strong evidence toward the diagnosis of Parkinson's disease (PD). Lower body parkinsonism is characteristic in idiopathic normal pressure hydrocephalus (INPH). We report an unusual INPH patient with marked asymmetric and upper body parkinsonism. An 83-year-old man presented with gait impairment and asymmetric clumsiness of movement. According to the Unified Parkinson's Disease Rating Scale (UPDRS), the motor subscore was 12 in the left limb and 8 in the right. The score was 14 for both the upper and lower body. After the cerebrospinal fluid tap test (CSFTT), he showed marked improvement in the upper body score. A loss of asymmetry of parkinsonian signs, with greater improvement in the left limb, was presented. Fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)-nortropane (F-18 FP-CIT) positron emission tomography (PET) imaging was normal. In the differential diagnosis of elderly patients presenting with parkinsonism compatible with PD, we might need to consider a diagnosis of INPH.


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