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Background: The subject of this study was how affective disorders are related to structural changes in the brain. The use of lithium in affective disorders can cause pseudotumor cerebri, which has been reported in the literature, although there is no information about the occurrence of normal pressure hydrocephalus. We detected normal pressure hydrocephalus in a patient diagnosed with bipolar affective disorder 10 years ago and treated with lithium.
Case: A 55 year-old woman, housewife, not working, lives in Istanbul with her husband and children. She was diagnosed with bipolar affective disorder 10 years ago and treated with lithium. She had hand tremors, weakness and dizziness and was admitted to hospital. The patient was dehydrated, walking with small steps, showed balance difficulty and urinary incontinence. The patient was admitted to the psychiatric unit. A neurology consultation and cranial MRI were requested. The patient was thought to have normal pressure hydrocephalus. Lumbar puncture was performed twice. The patient was diagnosed with arrested hydrocephalus; CSF şow could not be identified. A CSF dynamic MRI was requested and the patient was transferred to neurosurgery.
Discussion: There are publications about the relationship between structural brain abnormalities and affective disorders. Hydrocephalus, by definition, is the accumulation of CSF in the ventricular system due to an imbalance between production and absorption of CSF. Presenting symptoms include memory impairment, urinary incontinence symptoms, and ventriculomegaly (2,3). The etiology of normal pressure hydrocephalus can include head trauma, metabolic problems, endocrinopathies, infectious and immunological conditions; danazol, tamoxifen, oxytocin, tetracycline, indomethacin, lithium, drugs such as retinol are mentioned (2.4). Normal pressure hydrocephalus is not known to be associated with lithium in the literature. Lithium is known for its relationship with pseudotumor cerebri. Taking into account the patient saw benefits from lithium, it was decided to postpone to a change to the mood stabilizer.
References:
1. Arnone D, Cavanagh J, Gerber D, Lawrie SM, Ebmeier KP, Mclntosch AM. Magnetic resonance imaging studies in bipolar disorder and schizophrenia: meta-analysis. BJPsych 2009; 195:194-201.
2. Görgülü O, Yurt A, Özer FD, Turan Y. Normal basynçly hidrosefali ön tanyly 26 hastanyn analizi. Demans Dergisi 2003; 3:117-120.
3. Kempton MJ, Geddes JR, Ettinger U, Williams SCR, Grasby PM. Meta-analysis, Database, and Meta-regression of 98 Structural Imaging Studies in Bipolar Disorder. Arch Gen Psychiatry. 2008;65:1017-32.
4. Levine SH, Puchalski C. Pseudotumor cerebri associated with lithium therapy in two patients. J Clin Psychiatry. 1990; 51:251-3. Bulletin of Clinical Psychopharmacology