Idiopathic normal pressure hydrocephalus (iNPH) is a debated entity with controversial pathogenesis, diagnostic criteria, and predictors of response after ventriculoperitoneal shunt (VPS). Parkinsonian signs are frequently reported in the clinical picture, sometimes due to the coexistence of an underlying neurodegenerative parkinsonism and sometimes in the absence thereof. To distinguish these two scenarios is crucial, since they may carry different long-term response to CSF drainage. ¹²³I-FP-CIT-SPECT was believed to be helpful in this regard, however its role in predicting surgical outcome has been disputed. We illustrate a patient presented with gait disturbance, urinary incontinence, and asymmetrical parkinsonian signs, who underwent a 3T brain MRI and a ¹²³I-FP-CIT-SPECT. VPS was performed. The patient repeated a ¹²³I-FP-CIT-SPECT, 18 months after the operation, and was clinically followed up for 24 months. Our patient displayed clinical and radiological criteria for iNPH and an abnormal asymmetrical uptake in ¹²³I-FP-CIT-SPECT, consistent with her asymmetrical parkinsonism. However, the organization of the substantia nigra studied with iron-sensitive sequences in 3T brain MRI scan appeared intact. The patient revealed an improvement both clinically and in ¹²³I-FP-CIT-SPECT at postsurgical follow-up. Our report suggests that abnormal ¹²³I-FP-CIT-SPECT may not necessarily reveal an overlap with neurodegenerative parkinsonism; its partial reversibility may suggest that the mechanical effect exerted on the striatum by ventriculomegaly ultimately leads to downregulation of dopaminergic transporters which may improve after VPS.

特发性正常压力脑积水 (iNPH) 是一个有争议的实体，其发病机制、诊断标准和脑室腹腔分流术 (VPS) 后反应的预测指标存在争议。临床表现中经常报告帕金森症状，有时是由于潜在的神经退行性帕金森症并存，有时则不存在。区分这两种情况至关重要，因为它们可能对脑脊液引流产生不同的长期反应。¹²³ I-FP-CIT-SPECT 在这方面被认为是有帮助的，但它在预测手术结果中的作用一直存在争议。我们举例说明了一名出现步态障碍、尿失禁和不对称帕金森症状的患者，该患者接受了 3T 脑部 MRI 和¹²³I-FP-CIT-SPECT。进行了 VPS。患者在术后 18 个月重复¹²³ I-FP-CIT-SPECT，临床随访 24 个月。我们的患者表现出 iNPH 的临床和放射学标准以及¹²³ I-FP-CIT-SPECT 的异常不对称摄取，与她的不对称帕金森症一致。然而，在 3T 脑 MRI 扫描中用铁敏感序列研究的黑质组织似乎完好无损。患者在术后随访中显示临床和^{123 I-FP-CIT-SPECT 均有改善。}我们的报告表明，异常¹²³I-FP-CIT-SPECT 不一定揭示与神经退行性帕金森症的重叠；其部分可逆性可能表明脑室扩大对纹状体施加的机械效应最终导致多巴胺能转运蛋白的下调，这可能在 VPS 后得到改善。