SHM Converge Scientific Abstract ePoster Gallery-Occam vs. Hickam: Distinguishing Normal Pressure Hydrocephalus From Paraneoplastic Suspicions

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This case describes a 77-year-old woman with urinary incontinence, progressive confusion, falls, decreased speech, and anorexia, whose symptoms initially suggested normal pressure hydrocephalus (NPH). She also had recent hospitalizations for encephalopathy and imaging that revealed diffuse ventricular enlargement, a frontal lobe meningioma, and an acoustic neuroma. Her exam showed drowsiness, disorientation, impaired command-following, and poor posture, without focal neurologic deficits.<br /><br />Although she had the classic triad of NPH, the rapid decline and lack of improvement after a large-volume lumbar puncture raised concern for another cause. Serum testing was positive for GABAB receptor antibodies, and a typical carcinoid lung tumor was later found, making paraneoplastic limbic encephalitis seem plausible. However, the literature does not document a clear association between typical carcinoid tumors and paraneoplastic encephalitis. Immunotherapy did not improve her condition, prompting neurosurgical reassessment. She ultimately underwent ventriculoperitoneal shunt placement, which led to symptom resolution, supporting NPH as the primary diagnosis.<br /><br />The case highlights that failure to improve after lumbar puncture does not exclude NPH. It also emphasizes the importance of maintaining suspicion for NPH when other comorbid brain lesions may obscure diagnosis. Finally, the significance of isolated serum GABAB-R antibody positivity in the setting of a typical carcinoid tumor remains uncertain and requires further study.

Asset Subtitle

Austin M. Keller

Meta Tag

Author List Austin M. Keller, Michael McCafferty, Nolan Ladd

Category Clinical Vignettes

Concept Normal Pressure Hydrocephalus

Concept Urinary Incontinence

Concept Gait Instability

Concept Cognitive Decline

Concept Paraneoplastic Encephalitis

Distinguished Non-Finalist

Presenter Organization Northwestern University Feinberg School of Medicine - Department of Medicine

Presenting Author Austin M. Keller

Track Adult

Keywords

normal pressure hydrocephalus

urinary incontinence

progressive confusion

ventriculoperitoneal shunt

lumbar puncture

GABAB receptor antibodies

paraneoplastic limbic encephalitis

typical carcinoid tumor

ventricular enlargement

meningioma

Normal Pressure Hydrocephalus

Urinary Incontinence

Gait Instability

Cognitive Decline

Paraneoplastic Encephalitis