# Palinopsia in the Setting of Normal Pressure Hydrocephalus

## TL;DR

A 70-year-old woman with normal pressure hydrocephalus experienced unusual visual symptoms called palinopsia, which improved after treatment.

## Contribution

This case report highlights palinopsia as a rare visual symptom associated with normal pressure hydrocephalus.

## Key findings

- The patient's palinopsia resolved after ventriculoperitoneal shunt implantation.
- The patient showed sustained improvement in gait and urinary urgency following treatment.

## Abstract

Normal pressure hydrocephalus (NPH) is characterized by pathologic ventriculomegaly with normal opening pressures on lumbar puncture. It commonly presents with a triad of gait disturbance, cognitive impairment, and urinary bladder detrusor dysfunction. Its pathogenesis is complex but is thought to arise in the setting of imbalanced cerebrospinal fluid (CSF) secretion and absorption. Given that intracranial pressure often remains normal in the setting of NPH, visual symptoms are quite uncommon. Here we present a case of a 70-year-old female with a subacute history of visual aberration described as a seconds-long persistent recurrence of visual images after the stimulus was removed from the visual field in the setting of slowed and unstable gait, urinary urgency, and cognitive impairment. This patient was evaluated and ultimately diagnosed with NPH before undergoing definitive treatment with ventriculoperitoneal shunt implantation. She has shown persistent responsiveness to shunting of the CSF as manifested by sustained improvement in gait speed and stability, urinary bladder urgency, and palinopsia resolution at the six-month follow-up assessment.