Syndrome of normal pressure hydrocephalus: possible relation to hypertensive and arteriosclerotic vasculopathy

Abstract

A patient, a man of 67, with idiopathic normal pressure hydrocephalus, who had had no excellant response to shunting, was found at necropsy to have a severe hypertensive and arteriosclerotic vasculopathy with multiple lacunar infarcts. There was no pathologic evidence of thickened leptomeninges, fibrosis of the arachnoid villi, or Alzheimer's disease. An abnormal absorption mechanism was demonstrated with cisternography and by an increase in the concentration of homovanillic acid in the CSF. It is suggested that vascular changes may play an important role in the pathophysiology in some cases of normal pressure hydrocephalus.