Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Bradykinesia, Rigidity and Gait Disturbance Due to "Possible" Normal Pressure Hydrocephalus in a Patient with Anxiety and Bipolar Disorder : A Case Report

불안, 기분장애로 치료 중 보행장애 외에 서동과 강직을 동반한 정상뇌압수두증 증례

  • Jang, Sae Heon (Department of Psychiatry, Bongseng Memorial Hospital) ;
  • Jae, Young Myo (Department of Psychiatry, Bongseng Memorial Hospital) ;
  • Choi, Jin Hyuk (Department of Psychiatry, Bongseng Memorial Hospital) ;
  • Bae, Jung Hoon (Department of Psychiatry, Bongseng Memorial Hospital) ;
  • Seong, Sang Yoon (Department of Psychiatry, Bongseng Memorial Hospital) ;
  • Cho, Se Hoon (Department of Psychiatry, Bongseng Memorial Hospital) ;
  • Kim, Young Hoon (Department of Psychiatry, Bongseng Memorial Hospital)
  • 장세헌 (김원묵기념 봉생병원 정신건강의학과) ;
  • 제영묘 (김원묵기념 봉생병원 정신건강의학과) ;
  • 최진혁 (김원묵기념 봉생병원 정신건강의학과) ;
  • 배정훈 (김원묵기념 봉생병원 정신건강의학과) ;
  • 성상윤 (김원묵기념 봉생병원 정신건강의학과) ;
  • 조세훈 (김원묵기념 봉생병원 정신건강의학과) ;
  • 김영훈 (김원묵기념 봉생병원 정신건강의학과)
  • Received : 2015.03.28
  • Accepted : 2015.06.24
  • Published : 2015.06.30
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Abstract

In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.

정상뇌압수두증은 보행장애, 요실금 및 치매 등의 전형적인 세 가지 증상 외에도 추체외로 증상과 다양한 신경심리 증상이 동반될 수 있다. 이 사례는 불안과 정동증상으로 치료 중 보행장애와 요실금 증상을 보였던 46세 여자 환자에서 항파킨슨 약물의 사용과 기존 정신과 치료 약물의 중단에도 불구하고 증상의 호전이 없었으나, 뇌 컴퓨터 단층 촬영상 뇌실의 확장 소견이 보였고 시험적 뇌척수액 배액에 의해서 수일 내에 증상들이 극적으로 호전되어 정상뇌압수두증을 감별해야 했던 경우이다. 뚜렷한 대뇌 실질의 위축 소견이 없으나 뇌실이 확장되어 있을 경우 추체외로 증상과 신경심리 증상이 있을 경우 정상뇌압수두증의 전형적 세 가지 증상을 보이지 않는다 하더라도 정상뇌압수두증의 가능성을 고려해서 시험적 뇌척수액 배액 등의 시술이 진단과 치료에 도움이 될 수 있음을 보여주는 사례라고 생각된다.

Keywords

References

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