Objective: We here in report two patients of Parkinson disease patients who underwent DBS and developed NPH as a late event.

Background: Parkinsonism manifests distinctly in normal pressure hydrocephalus (NPH), and it’s recognized as an acute complication following deep brain stimulation (DBS) for Parkinson’s disease. However, the prevalence of NPH occurring years after DBS remains unclear, and whether it’s a complication or a coincidence is uncertain. Here, we present two cases of patients who developed NPH years after undergoing DBS

Method: We detail two cases of idiopathic Parkinson’s disease (IPD) wherein DBS surgery targeted the bilateral subthalamic nucleus (STN) and developed NPH

Results: Case 1: A 62-year-old female, diagnosed with IPD in 2003, underwent surgery in 2008. After several years of stability, she began experiencing a gradual decline in sensorium since December 2023. Initially, she presented with hyponatremia, which was corrected. However, there was minimal improvement even after correcting the electrolyte imbalance. Subsequent imaging indicated enlarged ventricles, raising suspicion of hydrocephalus. A VP shunt was performed following a positive CSF trial drainage, resulting in improved sensorium . Case 2: A 69-year-old male, diagnosed with IPD in 2010, underwent DBS surgery in 2015. Eight years post-surgery, he experienced gait disturbances with pronounced freezing and falls, with no improvement despite reprogramming using various configurations. Imaging revealed enlarged ventricles. Notably, his gait significantly improved after a trial cerebrospinal fluid (CSF) drainage, prompting consideration for ventriculoperitoneal (VP) shunt placement

Conclusion: While NPH is not typically considered a late complication of DBS in IPD, clinicians should have a high index of suspicion of NPH for those with unexplained and unresolvable issues in post-DBS patients, particularly those who initially showed improvement.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/normal-pressure-hydrocephalus-in-two-parkinsons-disease-patients-with-deep-brain-stimulation-co-occurrence-or-complication/