065 Obstructive hydrocephalus presenting primarily as a corpus callosum disconnection syndrome: a case report
Background The corpus callosum disconnection syndrome is characterised by left sided apraxia to command, left sided tactile and visual neglect for objects presented to the subjects left side, poor left auditory perception, right sided anosmia and the corpus callosum alien hand syndrome. It has been reported in several disorders of the corpus but there are very few case reports associated with hydrocephalus; a pubmed search has identified only one case.
Case report We present a 47 year old right-handed van driver with a 5-year history of progressive difficulty distinguishing which of his hands was holding an object (tactile neglect) or which hand he was moving. He may drop an object from the hand he did not intend and this was predominantly with the left side. His left hand often moved involuntarily when he moved his right hand (diagnostic dyspraxia) but there was no evidence of mirror movements or intermanual conflict. There was no apraxia or prosopagnosia. He had no focal neurological deficits apart from slightly brisker reflexes in his right limbs. Magnetic resonance image of his brain (MRI) showed dilated lateral and third ventricles with thinning and displacement of the corpus callosum as well as aqueductal stenosis. He reported significant improvement but not complete resolution of his symptoms after endoscopic third ventriculostomy.
Conclusion Our patient presented with features of dysfunction of the corpus callosum and who demonstrated typical characteristics of corpus callosum disconnection which improved after surgery. There was little in his presentation to suggest the diagnosis of obstructive hydrocephalus which was however prominent on imaging.