200 Section - Functional Recovery in Normal Pressure Hydrocephalus Secondary to Long-COVID

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

DW

Derrick P. Williams, Jr., MD

Resident Physician
UT Houston - TIRR
HOUSTON, Texas, United States
PT

Prabhu Tewari, MD

Brain Injury Medicine Fellow
TIRR
Houston, Texas, United States

Co-Author/Coautor(s)

ML

Matthew Lin, MD

Assistant Professor
UTHealth Science Center at Houston
Houston, Texas, United States
MD

Mark Dannenbaum, MD

Attending Physician
UTHealth Houston
Houston, Texas, United States

Case Diagnosis: Normal pressure hydrocephalus as a complication of COVID-19 infection.

Case Description: A 54-year-old male paramedic and graduate student with prior hospitalization due to COVID-19, presented to the Long-COVID clinic with mood lability, brain fog, headaches, fatigue and insomnia. Despite two years of targeted treatments, he remained unable to return to work nor school due to worsening gait stability, cognitive impairment, and urinary retention. CT brain imaging demonstrated ventricular dilation disproportionate to sulcal space, consistent with normal pressure hydrocephalus (NPH). Notably, he had no other identifiable risk factors for developing NPH. Large volume lumbar puncture (LVLP) was performed and the patient demonstrated improvements in timed-up-and-go, dynamic gait index, and Berg balance. These findings were re-demonstrated on repeat LVLP, leading to ventriculo-peritoneal shunt (VPS) placement. Following VPS placement, the patient has had profound functional improvement in both physical and cognitive domains, allowing for return to work and school full-time.

Discussions: Normal pressure hydrocephalus (NPH) is theorized to develop as a sequelae of COVID-19 due to direct infiltration of the virus into the choroid plexus along with chronic inflammation disrupting cerebral spinal fluid flow and decreasing its uptake via arachnoid granulations. NPH is classically characterized by the triad of gait impairment, cognitive decline, and urinary incontinence. Given the functional impact of these symptoms and their potentially devastating severity, NPH, if suspected, should be promptly worked up and treated in the Long-COVID patient population.

Conclusions: Normal pressure hydrocephalus (NPH) should be considered as a complication of COVID-19 infection, particularly in the setting of combined gait and cognitive impairments. CT imaging of the brain and large volume lumbar puncture can help make the diagnosis. Significant functional gains can be made through definitive treatment of the NPH by shunting.