IntroductionNormal Pressure Hydrocephalus (NPH) is one of the causes of potentially treatable dementia and presents with characteristic triad of gait apraxia, cognitive impairment \RL and urinary incontinence. Typically, it is associated with normal cerebrospinal fluid (CSF) pressure and ventriculomegaly that is disproportionate to amount of cerebral atrophy. Relkin et al. proposed the diagnostic criteria for idiopathic NPH (iNPH) which was classified into probable, possible, and unlikely categories (1).There is a transient improvement in symptoms after a large-volume lumbar tap or a short-term lumbar drain. In clinical point of view, this technique is applied for prediction of patient who may respond to shunt surgery. Furthermore, serial lumbar tap may be as a therapeutic option for patients with NPH who are not good candidate for surgery.CSF leak have been classified into traumatic and spontaneous (2). Spontaneous (non traumatic) CSF leak is an uncommon, but well documented presenting feature of a wide variety of intracranial pathologies including hydrocephalus, tumor, increased intracranial pressure, congenital anomalies or unknown causes (2, 3). Rarely, it may be a presenting feature of NPH, which was reported previously in the context of aqueductal stenosis (4, 5).Here, we report an adult patient with NPH suffering from dementia and gait disturbance who developed spontaneous CSF leakage from his nose that led to dramatic improvement in gait and cognitive function. To our best knowledge, it is the first report of spontaneous CSF rhinorrhea in patients with NPH.
