Hydrocephalus presenting with an epileptic seizure in a patient without neurological or significant cognitive deficit

Abstract

Neurological diseases with epileptic and cognitive impairment require the exclusion of structural brain lesions. These include cases of compensated hydrocephalus with increased cerebrospinal fluid pressure, in which minimal triggers can lead to decompensation. The altered dynamics of the cerebrospinal fluid predispose greater vulnerability of the brain from age-related factors, with faster cognitive decline. The discrepancy between the degree of structural changes and clinical manifestations is subject to discussion in the literature. We describe a patient hospitalized because of a bilateral tonic-clonic seizure during sleep, followed by drowsiness and confusion for several hours. Brain CT revealed chronic hydrocephalus with obstruction of the aqueduct. The patient was referred for surgical treatment. The clinical case demonstrates an epileptic seizure as a reason for imaging in high-grade hydrocephalus. The discrepancy between altered brain structures and generally preserved cognitive state is considered an example of the compensatory abilities of the brain and the importance of neuroplasticity.