Spontaneous CSF Leakage Leading to Symptomatic Improvement in a Patient with Normal Pressure Hydrocephalus: A Case Report

Normal Pressure Hydrocephalus (NPH) is a reversible cause of dementia that often responds to Cerebrospinal Fluid (CSF) drainage. Spontaneous CSF leakage is rare in this setting. We report a 79-year-old man with urinary incontinence, gait disturbance, and cognitive decline, diagnosed with probable NPH. Serial lumbar punctures led to marked improvement. During a treatment delay due to the COVID-19 pandemic, he developed spontaneous CSF rhinorrhea, which was followed by further symptomatic relief. This case suggests that spontaneous CSF leakage may temporarily replicate the therapeutic effects of CSF drainage, offering insight into symptom fluctuation and potential diagnostic markers in NPH.