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Normal Pressure Hydrocephalus — SCE Neurology MCQ

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HardNeurodegenerative DiseaseNormal Pressure HydrocephalusSCE Neurology

A 75-year-old man presents with a 1-year history of progressive gait difficulty, urinary incontinence, and cognitive decline. CT brain shows ventriculomegaly out of proportion to sulcal widening. What additional investigation would support the suspected diagnosis?

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Correct answer: A — Large-volume lumbar puncture with gait assessment before and after

The best answer is “Large-volume lumbar puncture with gait assessment before and after”. Dementia diagnosis integrates chronology, cognitive phenotype, function, imaging and reversible contributors; Lewy-body disease requires particular caution with antipsychotics because severe sensitivity can occur. The alternatives “Serum vitamin B12 level, after excluding important mimics”, “EEG, after specialist assessment, when the phenotype supports it”, “Serum ceruloplasmin, when the phenotype supports it”, “Anti-neuronal antibodies, within the relevant UK pathway” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG97 dementia recommendations: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations