Abstract
Background The incidence of hydrocephalus with vestibular schwannoma (VS) ranges from 3.7–42%. Interestingly, communicating hydrocephalus is more common (61–87.8%). Stereotactic radiotherapy, a treatment option for VS, has been reported to precipitate communicating hydrocephalus, with an incidence between 3.4 and 14%. However, its pathophysiology remains debatable. Normal pressure hydrocephalus is often thought of in a presentation with a triad of disordered gait, urinary incontinence, and dementia of an elderly patient in the neurology clinic. We present a case with VS as a cause of communicating hydrocephalus.
Case A woman in her 70s presented with a 1-year history of progressive cognitive decline and recurrent falls several weeks after elective stereotactic radiotherapy to her right-sided VS. She was initially managed as a primary neurodegenerative disorder. On examination, she was predominantly wheelchair-bound, with a shuffling gait on short strides. Her Montreal Cognitive Assessment score was 8. She was also urinary incontinent. Neuroimaging showed communicating hydrocephalus. Her lumbar puncture protein was elevated at 1.01 g/L, but otherwise unremarkable with a negative infective, autoimmune and paraneoplastic screening. Her cerebrospinal fluid opening pressure was 38cmH2O, with a negative CSF tap test. A ventriculoperitoneal shunt was inserted. Five months later, she walked independently, her cognition was normal, and her urinary symptoms had resolved.
Conclusion Communicating hydrocephalus secondary to vestibular schwannoma is a rare cause of a reversible progressive cognitive decline and gait disturbance.
