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Normal Pressure Hydrocephalus — RACP Adult Medicine MCQ

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ModerateNeurologyNormal Pressure HydrocephalusRACP Adult Medicine

A 65-year-old man with a history of falls presents with gradual cognitive decline, gait apraxia, and urinary incontinence over 6 months. CT brain shows enlarged ventricles (Evans index >0.3) out of proportion to cortical atrophy. Sulci are effaced. What is the most likely diagnosis?

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Correct answer: D — Normal pressure hydrocephalus

The classic triad of gait apraxia (magnetic gait), cognitive decline (subcortical dementia), and urinary incontinence (wet, wacky, wobbly) with ventriculomegaly out of proportion to cortical atrophy is normal pressure hydrocephalus. Despite the name, LP opening pressure is usually normal-high normal. Diagnosis: clinical triad + ventriculomegaly + improvement after large-volume LP (30-50 mL). Treatment: VP shunt if LP trial positive.

Reference: eTG Neurology – 2024 – NPH; JNSPG 2024 NPH Guidelines