Progressive ataxia, cognitive decline, urinary incontinence, and unexplained hydrocephalus: a rare case of idiopathic normal pressure hydrocephalus in epileptic patient.

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) poses diagnostic challenges due to its overlapping symptoms with other neurodegenerative disorders. The clinical trial of gait disturbance, cognitive impairment, and urinary incontinence often mimics other conditions, making accurate diagnosis crucial. Case presentation: A 67-year-old male with a 40-year history of epilepsy presented with progressive gait abnormalities, cognitive decline, and bladder incontinence over 5 years. Initial evaluation revealed a magnetic gait, impaired short-term memory, and a Mini-Mental State Examination score of 17/30. MRI and CT scans showed ventriculomegaly without elevated cerebrospinal fluid (CSF) pressure. A lumbar puncture with a positive CSF tap test confirmed iNPH, and ventriculoperitoneal shunt surgery was performed, resulting in significant improvement in symptoms. Discussion: iNPH is characterized by the triad of gait disturbance, cognitive impairment, and urinary incontinence. Its diagnosis is primarily based on clinical presentation and neuroimaging. The CSF tap test is a crucial diagnostic tool, and shunt surgery remains the standard treatment. This case underscores the need for a high index of suspicion for iNPH in patients with atypical presentations and emphasizes the importance of long-term follow-up to monitor treatment efficacy. Conclusion: This case highlights the complexity of diagnosing iNPH, particularly in patients with comorbid conditions such as epilepsy. Thorough diagnostic evaluations and timely intervention are critical for improving patient outcomes. Long-term monitoring is essential to assess the effectiveness of treatment and manage potential complications.