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Normal Pressure Hydrocephalus — RACP Adult Medicine MCQ

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ModerateNeurologyNormal Pressure HydrocephalusRACP Adult Medicine

A 78-year-old man presents with confusion, urinary incontinence, and gait disturbance with magnetic gait (feet appearing stuck to the floor). CT brain shows ventriculomegaly disproportionate to sulcal atrophy. What is the most likely diagnosis?

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Correct answer: B — Normal pressure hydrocephalus

The classic triad of gait disturbance (magnetic gait), cognitive impairment, and urinary incontinence with ventriculomegaly out of proportion to cortical atrophy on imaging is diagnostic of normal pressure hydrocephalus. A large-volume CSF drainage trial (30–50 mL) with gait assessment before and after is diagnostic. Definitive treatment is VP shunt.

Reference: eTG Neurology – 2024 – Dementia; AAN NPH Guidelines