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Normal pressure hydrocephalus — SCE Neurology MCQ

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ModerateMovement DisordersNormal pressure hydrocephalusSCE Neurology

A 27-year-old woman presented with gait freezing, urinary urgency and cognitive slowing over a year. On examination, there was broad-based magnetic gait with relatively preserved arm swing. Initial investigations showed: MRI showed ventriculomegaly out of proportion to sulcal atrophy. What is the most likely underlying mechanism?

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Correct answer: C — impaired CSF dynamics causing periventricular dysfunction

impaired CSF dynamics causing periventricular dysfunction is the best answer because the vignette describes Normal pressure hydrocephalus: triad with disproportionate ventriculomegaly suggests NPH. Large-vessel thromboembolism is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Functional abnormality of motor prediction networks and Granulomatous vessel wall inflammation are less appropriate because they would require different localisation, timing or test findings; Alpha-synuclein neurodegeneration would fit a different syndrome. Clinical pearl: Parkinson's disease would show asymmetric bradykinesia and rest tremor.

Reference: NICE NG71; Movement Disorder Society consensus criteria