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Normal pressure hydrocephalus and acute encephalopathy: case report An 80-year-old man developed acute encephalopathy and normal pressure hydrocephalus (NPH) during treatment with valproate semisodium for behavioural and psychological symptoms of dementia (BPSD). The man, who had a history of hypertension and diabetes mellitus–Type 2 for 5 years, and bronchial asthma and BPSD, was admitted after experiencing bilateral swaying on sitting and difficulty in walking since one day. His medications included enalapril and nebivolol for hypertension, ipratropium bromide/salbutamol [duolin] for bronchial asthma, and quetiapine and valproate semisodium [Divalproex sodium] 125mg [route not stated] for BPSD. He was started on valproate semisodium at 2 months before the current presentation for better control of symptoms. The brain CT-scan revealed reduced callosal angle with dilation of the ventricular system, which suggested NPH. Additionally, small vessel ischaemic changes with age‑related diffuse cerebral atrophy were also observed. The EEG demonstrated diffused severe encephalopathy, which confirmed diagnoses of NPH and acute encephalopathy. The man’s treatment with valproate sodium was discontinued following the diagnoses of NPH and acute encephalopathy. Subsequently, the dose of quetiapine was increased along with the addition of dopamine and donepezil/memantine for BPSD. He was discharged after improvement of symptoms within a week. However, haematological reports were indicative of beta‑thalassaemia trait. According to causality assessment using WHO‑UMC causality system and Naranjo adverse drug reaction probability scale, there was a probable correlation between valproate sodium use and occurrence of NPH. The severity of the NPH was assessed suggested Level 4a (using Hartwig et al. scale). Kamath S, et al. Valproic acid-induced normal pressure hydrocephalus in a tertiary care hospital. Journal of Pharmacology and Pharmacotherapeutics 11: 72-74, No. 2, Jun 803518872 2020. Available from: URL: http://doi.org/10.4103/jpp.JPP_111_19

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Reactions 5 Dec 2020 No. 1833