A Puzzling Case of Normal Pressure Hydrocephalus in the Outpatient Setting

Normal Pressure Hydrocephalus (NPH) is a disease of adulthood characterized by the triad of gait disturbance, dementia, and urinary incontinence. Since NPH shares a lot of characteristics with other disorders including neurodegenerative disorders and degenerative-dystrophic spine, it is usually underdiagnosed and undertreated. Combination of ventriculomegaly seen on a computerized tomography (CT) scan or magnetic resonance imaging (MRI) with clinical findings could be used in diagnosis of NPH. However, improvement of symptoms post spinal tap procedure would be a better indication of diagnosis. Currently, shunt placement is the best available modality of treatment for NPH. Here we present a case of a 72-year-old male who presents with 3 months of worsening shuffling gait, persistent urinary incontinence, and recent memory issues. Due to his comorbid conditions of bladder cancer, BPH, HIV, and lumbar stenosis he has been treated separately for each of these symptoms, which made it difficult to consider NPH as a differential diagnosis early on in the course of his medical presentation. This case presentation of NPH is unique due to the presence of concurrent comorbidities that can mask the classic triad of NPH making the diagnosis difficult. This case could be used as a guideline for providers in an outpatient setting who might face similar patient presentations