Normal pressure hydrocephalus dementia — SCE Neurology MCQ
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Correct answer: A — Specialist normal-pressure-hydrocephalus assessment and neurosurgical review of shunt suitability, after review
The best answer is “Specialist normal-pressure-hydrocephalus assessment and neurosurgical review of shunt suitability, after review”. The clinical and imaging pattern suggests idiopathic normal-pressure hydrocephalus, a potentially shunt-responsive syndrome requiring specialist selection rather than automatic surgery. “Start levodopa without evaluating hydrocephalus” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Diagnose Alzheimer disease solely from age” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Offer emergency lorazepam” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Treat with immunotherapy for autoimmune encephalitis” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.
Reference: NICE NG97 dementia recommendations: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations