A male patient with pseudobulbar affect caused by post-traumatic normal pressure hydrocephalus successfully managed with ventriculoperitoneal shunt

Abstract

Background and importance: Pseudobulbar affect (PBA) is characterized by sudden, uncontrollable laughing, crying, or both in the absence of an appropriate triggering stimuli. Usually due to an underlying neurological condition, PBA has been reported less commonly in traumatic brain injury (TBI) and patients with normal pressure hydrocephalus (NPH). This case documents the successful management of a male patient with PBA and post-traumatic NPH with ventriculoperitoneal shunt placement. Clinical presentation: An 88-year-old male initially presenting with acute right subdural hematoma after a fall underwent right decompressive hemicraniectomy and cranioplasty. On 2-month follow-up, the patient was diagnosed with PBA as well as post-traumatic hydrocephalus, confirmed with Center for Neurologic Study – Liability Scale (CNS-LS) questionnaire as well as a cerebrospinal fluid tap test (CSF-TT), respectively. The patient underwent ventriculoperitoneal shunt placement with successful resolution of PBA and post-traumatic NPH. Conclusion: A select subset of patients presenting with post-traumatic NPH may demonstrate successful resolution of PBA symptoms following surgical intervention to address the underlying neurological disorder potentiating pseudobulbar affect.

Keywords

• Pseudobulbar affect
• Normal pressure hydrocephalus
• Ventriculoperitoneal shunt