Normal Pressure Hydrocephalus — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGeriatric MedicineNormal Pressure HydrocephalusRACP Adult Medicine

A 78-year-old woman presents with confusion, urinary incontinence, and gait disturbance with a wide-based, magnetic gait. CT brain shows ventriculomegaly out of proportion to cortical atrophy. What investigation should be performed to assess for the likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Lumbar puncture with CSF drainage trial

The classic triad of gait disturbance (often the earliest and most responsive feature), urinary incontinence, and cognitive impairment with ventriculomegaly disproportionate to atrophy suggests normal pressure hydrocephalus (NPH). A high-volume lumbar puncture (30–50 mL CSF removal) with assessment of gait before and after drainage is the diagnostic test. Improvement predicts response to ventriculoperitoneal shunt.

Reference: eTG – 2025 – Neurology; EAN – 2020 – NPH Guidelines