SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Uncertainty in Suspected Normal Pressure Hydrocephalus Complicated by Alcohol Use and Ama Departure

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This case describes a 50-year-old woman with alcohol use disorder who presented after a week of heavy drinking with generalized weakness, fatigue, progressive imbalance, and a recent fall with head injury. She had a history of recurrent alcohol-related falls and prior withdrawal seizure, along with asthma/COPD, hypertension, and knee replacement.<br /><br />On exam, she was tired but alert, tachycardic, hypertensive, tremulous, and had an ataxic gait. She also had mild wheezing and a cheek abrasion. Labs showed severe intoxication (ethanol 467 mg/dL), hyponatremia, hypomagnesemia, thrombocytopenia, leukopenia, mild anemia, and elevated AST, all of which could contribute to her neurologic symptoms.<br /><br />Brain imaging raised concern for normal pressure hydrocephalus (NPH): CT showed mild to moderate ventricular enlargement out of proportion to sulcal enlargement. However, MRI also demonstrated moderate diffuse cortical volume loss, chronic small-vessel ischemic changes, and central atrophy, making the diagnosis uncertain. The main differential included NPH, hydrocephalus ex vacuo, and alcohol-related neurodegeneration.<br /><br />The case highlights how neurologic symptoms in patients with substance use disorders can be difficult to interpret because imaging abnormalities may overlap with alcohol-related atrophy and vascular disease. It emphasizes the need to consider metabolic and clinical contributors such as intoxication and electrolyte disturbances alongside neuroimaging findings.<br /><br />Potential missed opportunities included formal gait testing, cognitive evaluation, and a large-volume lumbar puncture, but these were limited because the patient left against medical advice. The report underscores the importance of early multidisciplinary assessment to reduce diagnostic delay and morbidity in vulnerable patients with complex neurologic presentations.

Asset Subtitle

Maria Mustafa

Meta Tag

Author List Maria Mustafa, Sunil Patel

Category Clinical Vignettes

Concept Normal Pressure Hydrocephalus

Concept Gait Instability

Concept Falls

Concept Hydrocephalus ex Vacuo

Concept Intoxication

Distinguished Non-Finalist

Presenter Organization Northwest Health Porter/ Healthlinc

Presenting Author Maria Mustafa

Track Adult

Keywords

alcohol use disorder

normal pressure hydrocephalus

ventricular enlargement

ataxic gait

ethanol intoxication

electrolyte disturbances

hydrocephalus ex vacuo

cortical atrophy

small-vessel ischemic changes

withdrawal seizure

Normal Pressure Hydrocephalus

Gait Instability

Falls

Hydrocephalus ex Vacuo

Intoxication