(Kiosk 6) New-onset Hydrocephalus of Unknown Cause in an Adult with Cerebral Palsy: A Case Report

Case Diagnosis: New-Onset Hydrocephalus in an Adult with Cerebral Palsy: A Case Report

Case Description or Program Description: A 27-year-old female with mixed dyskinetic-spastic cerebral palsy (CP) presented with subacute bilateral lower extremity spasms. Multiple interventions were trialed without significant improvement, including: pain and tone management injections, multiple oral and topical medications , and physical and massage therapies. Due to lack of improvement with aforementioned interventions, imaging of the neuraxis was obtained and demonstrated new diffuse moderate ventriculomegaly compared to baseline. Further work-up was notable for papilledema and elevated opening pressure on lumbar puncture. Clinical picture was consistent with new-onset hydrocephalus.

Setting: Quaternary care adult physical medicine & rehabilitation clinic

Assessment/Results: The patient underwent ventriculoperitoneal shunt replacement with rapid and near-resolution of her symptoms.

Discussion (relevance): Hydrocephalus is a common comorbidity associated with brain injuries, including CP. However, in CP, hydrocephalus typically presents in early childhood or infancy. Given the new-onset of non-obstructive hydrocephalus in this adult-aged patient with CP, this is a unique and complex case. Despite the clinical course and evaluation consistent with non-obstructive hydrocephalus, no causative preceding neurologic process such as acute hemorrhage or infection was identified.

Conclusions: This case highlights the critical need for ongoing neurologic surveillance in adults with CP. Adults with CP require comprehensive evaluation for neurologic causes for changes in or development of new symptoms, including changes in baseline hypertonia, especially in a non-progressive condition such as CP. Earlier identification in our patient may have led to earlier shunting, prevention of excessive procedures, and earlier symptomatic improvement. With a diagnosis as heterogeneous as CP, the risk of hydrocephalus may vary depending on type, distribution, and/or etiology of CP. However, the growing population of adults with CP warrants increased attention to better understanding their unique health risks.