A CASE OF PERSISTENT AND VARYING BEHAVIOURAL ABNORMALITIES WITH NORMAL PRESSURE HYDROCEPHALUS

A twenty year old, unmarried male presented with irritability, anger outbursts, and assaultive behaviour for the past five years. Initially he also had features suggestive of schizophrenia like withdrawn behaviour, talking to self, making gestures, suspicious, irrelevant talk and obsessive symptoms. On treatment with antipsychotics and anti depressant, he improved without attaining premorbid level of functioning and remained in that state for four years. Thereafter he was diagnosed as Bipolar affective disorder-mania as he developed more irritability, excessive speech and motor activities. Treatment with mood stabilizer and electroconvulsive therapy for four months has ended in poor response. Later he exhibited episodic aggression and his electroencephalographic changes showed abnormalities suggestive of complex partial seizure. Magnetic resonance image findings revealed evidence of uniform dilatation of all the ventricles without peri ventricular changes and a diagnosis of normal pressure hydrocephalus was made. During these times his weight increased and thyroid function tests revealed hypothyroidism, which further complicated the course of the illness. Even with adequate treatment, his behavioural abnormalities continued in attenuated form with various diagnostic possibilities, posing a challenge for treatment.