title: Hydrocephalic Parkinsonism: lessons from normal pressure hydrocephalus mimics.
abstract: BACKGROUND
  Hydrocephalus is an under-recognized presentation of progressive supranuclear palsy (PSP) and dementia with Lewy bodies (DLB).
  
  
  METHODS
  We describe four normal pressure hydrocephalus (NPH)-like presentations of pathology-proven PSP (n = 3) and DLB (n = 1) and review the literature on the hydrocephalic presentation of these atypical parkinsonisms.
  
  
  RESULTS
  Despite the presence of ventriculomegaly disproportionate to the extent of parenchymal atrophy, all patients demonstrated early postural impairment and/or oculomotor abnormalities that encouraged a diagnostic revision. Hallucinations were the only early atypical manifestation of the hydrocephalic DLB presentation.
  
  
  CONCLUSIONS
  Early postural impairment, falls, oculomotor impairment, and/or hallucinations are inconsistent with the diagnosis of NPH and suggest PSP or DLB as the underlying NPH mimic. We postulate that previously reported cases of "dual" pathology (e.g., NPH and PSP) actually represent the hydrocephalic presentation of selected neurodegenerative disorders.
authors.affiliation: Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St, Suite 2300, Cincinnati, OH 45267-0525 USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Starr
authors.affiliation: Department of Pathology, Division of Neuropathology, University of Cincinnati, Cincinnati, OH USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Hagen
authors.affiliation: Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St, Suite 2300, Cincinnati, OH 45267-0525 USA.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
keywords: Dementia with Lewy bodies; Normal pressure hydrocephalus; Progressive supranuclear palsy; Ventriculomegaly