Hydrocephalus - Misdiagnosis

Hydrocephalus, also known as "water in the brain" is defined as complex and multifactorial neurological disorders of accumulation of cerebrospinal fluid (CSF) in the cavity of brain of that can lead to intracranial pressure inside the side, resulting of brain trauma, stroke, infection, tumor, etc.
Misdiagnosis
 Because some of these symptoms may also be experienced in other disorders, sometimes normal pressure hydrocephalus is  incorrectly diagnosed and never properly treated, including
1. Tuberculosis
Neurosarcoidosis, a complication of sarcoidosis in which inflammation occurs in the brain, spinal cord, and other areas of the nervous system is observed in approximately 5% of sarcoidosis. Its common manifestations are facial palsy (50% of patients with neurosarcoidosis) and optic neuritis. Hydrocephalus is a very uncommon reported finding. Although the typical presentation of sarcoidosis such as facial palsy is not a diagnostic dilemma, more atypical presentations such as hydrocephalus with altered mentality in a tuberculosis patient can lead to a misdiagnosis(24).

2. Alzheimer's disease
Dr. Silverberg GD and scientists at the Stanford University School of Medicine in the study of Alzheimer's disease and normal-pressure hydrocephalus, suggested that if all else being equal, the initially dominant physiological change determines whether CSF circulatory failure manifests as Alzheimer's disease (AD) or as normal-pressure hydrocephalus (NPH). If CSF production failure predominates, AD develops. However, if resistance to CSF outflow predominates, NPH results. Once either disease process takes hold, the risk of the other disorder may rise. In AD, increased deposition of Abeta in the meninges leads to greater resistance to CSF outflow. In NPH, raised CSF pressure causes lower CSF production and less clearance of Abeta(25).

3. Parkinson's disease
There are several reports of cases with the characteristic clinical manifestations of normal pressure hydrocephalus--progressive dementia, gait difficulty and urinary incontinence--have been published earlier, it was Adams and Hakim who emphasized the clinical triad and the effect of shunting the cerebrospinal fluid as a means of treatment. Messert and Baker stressed that the gait disturbance had a close resemblance to the freezing gait of parkinsonism but Dr. Lobo Antunes J, and the the research team suggested that recognition of the existence of both disorders in the same patients is important since appropriate treatment of each of them led to marked improvement of their symptoms(26).

4. Creutzfeldt-Jakob disease
There is a report of  two different dementing diseases, Creutzfeldt-Jakob disease and normal-pressure hydrocephalus in a single patient. The inefficacy of a shunt procedure in this particular case, and the need of a brain biopsy in patients with normal-pressure hydrocephalus before undergoing cerebrospinal fluid shunting are stressed. A purely coincidental occurrence, or a possible aetiopathogenic relationship between both diseases are postulated(27).

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Sources
(24) http://www.ncbi.nlm.nih.gov/pubmed/20717518
(25) http://www.ncbi.nlm.nih.gov/pubmed/12878439
(26) http://www.ncbi.nlm.nih.gov/pubmed/6583309
(27) http://www.ncbi.nlm.nih.gov/pubmed/6989174