Homonymous Hemianopsia in Normal Pressure Hydrocephalus

Homonymous hemianopsia (HH) without structural correlate on neuroimaging has a limited differential diagnosis (occipital seizure, subclinical ischemia, nonketotic hyperosmolar hyperglycemia, Heidenhein variant prion disease, or posterior cortical atrophy (PCA)). In elderly patients with progressive neurocognitive deficits over months to years and a HH with normal or near normal structural brain imaging, the cause is usually thought to be PCA. We report a case of reversible neurologic and visual symptoms and signs in normal pressure hydrocephalus (NPH) in an elderly patient treated with a ventriculo-peritoneal shunt. To our knowledge this is the first case to be described in English-language ophthalmic literature.