Normal Pressure Hydrocephalus Mimicking Antipsychotic-induced Parkinsonism

擬似藥物引起類巴金森氏症之常壓性水腦症

10.29478/TJP.200906.0009

陳廷任(Ting-Jen Chen)；歐陽文貞(Wen-Chen Ouyang)；曾美智(Mei-Chih Tseng)；李明濱(Ming-Been Lee)；陳錫中(His-Chung Chen)

常壓性水腦症 ； 類巴金森氏症狀 ； normal pressure hydrocephalus ； parkinsonism syndromes

台灣精神醫學

23卷2期（2009 / 06 / 01）

167 - 171

英文

目的：由於常壓性水腦症的臨床表現多樣化，臨床上要在有精神疾病病史之患者中診斷出常壓性水腦症並不容易。本文報告一患有常壓性水腦症的慢性精神分裂症個案。病例报告：一位47歲慢性精神分裂症女性患者，於復健病房住院中出現錐體外症候群如小碎步、易跌倒等情形，由於病情無法單以藥物副作用解釋，後經電腦斷層診斷為常壓性水腦症，經過腦室腹膜分流手術，上述錐體外症候群逐漸進步。結論：常壓性水腦症的症狀表現和許多精神疾病，及抗精神病藥物副作用相似。如果精神分裂症病患者出現步態與運動障礙，且治療效果不佳時，宜考慮其他腦部疾病，包括常壓性水腦症。

Objective: Normal pressure hydrocephalus (NPH) is a diagnostic challenge for clinicians due to significant variations in its clinical presentation, especially in patients with a psychiatric history. Case Report: A 47-year-old female with chronic schizophrenia had extrapyramidal symptoms (EPS) while being admitted on the psychiatric ward. Her EPS were initially considered to be induced by antipsychotic drugs, but the symptoms persisted despite adjustments in medication. The finding of the computed tomographic scan later revealed NPH. After being implanted a ventriculo-peritoneal shunt, her EPS were gradually improved. Conclusion: The typical symptoms of NPH are similar to some of the common mental disorders, or the side effects induced by antipsychotic drugs. NPH is suggested to be considered when schizophrenic patients are presenting a gait or movement disturbance but with poor response to the management for EPS.

1. Bird TD,Eugene Braunwald(eds.),Anthony S. Fauci(eds.),Dennis L. Kasper(eds.)(2001).Harrison's Principles of Internal Medicine.New York:McGraw-Hill.
2. Gallia GL,Rigamonti D,Williams MA(2006).The diagnosis and treatment of idiopathic normal pressure hydrocephalus.Nat Clin Pract Neurol,2,375-381.
3. Hirose G(2006).Drug induced parkinsonism: a review.J Neurol,253(3),22-24.
4. Krauss JK,Regel JP,Vach W,Droste DW,Borremans JJ,Mergner T(1996).Vascular risk factors and arteriosclerotic disease in idiopathic normal-pressure hydrocephalus of the elderly.Stroke,27,24-29.
5. Mena MA,de Yébenes JG(2006).Drug-induced parkinsonism.Expert Opin Drug Saf,5,759-771.
6. Nowak DA,Topka HR(2006).Broadening a classic clinical triad: The hypokinetic motor disorder of normal pressure hydrocephalus also affects the hand.Exp Neurol,198,81-87.
7. Stolze H,Kuhtz-Buschbeck JP,Drücke H,Jöhnk K,Illert M,Deuschl G(2001).Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease.J Neurol Neurosurg Psychiatry,70,289-297.
8. Vacca V(2007).Diagnosis and treatment of idiopathic normal pressure hydrocephalus.J Neurosci Nurs,39,107-111.
9. Verrees M,Selman WR(2004).Management of normal pressure hydrocephalus.Am Pam Physician,70,1071-1078.