Valproic acid-induced normal pressure hydrocephalus in a tertiary care hospital

Behavioral and psychological symptoms of dementia (BPSD) are a common psychological disorder in the geriatric population with dementia. The causes and risk factors are multiple, and they include biological, psychological, and environmental variables. The combination of these symptoms, rather than any specific factor, explains the occurrence of BPSD in an individual patient. Treatment is targeted to a specific symptom; anticonvulsants such as valproic acid (VPA), carbamazepine, and anti-psychotics have been used to treat agitation in elderly patients. Atypical antipsychotics are used to treat psychosis, and Selective Serotonin Reuptake inhibitors are used to treat depression and anxiety. VPA is dosed using the weight-based dosing approach, which is usually found to be very safe and effective in elderly patients. However, in certain cases, it has also been known to produce reversible neurological symptoms such as dementia, altered sensorium, psychological disturbances, and normal pressure hydrocephalus (NPH) on its prolonged use. The present case report is unique as we identified that an elderly patient with a history hypertension, type 2 Diabetes and asthma, and BPSD was diagnosed with NPH after a short-term treatment with Divalproex sodium-125 mg which is once daily which was added on to his on-going therapy to better control his symptoms.