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Normal pressure hydrocephalus dementia — SCE Neurology MCQ

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HardCognitive NeurologyNormal pressure hydrocephalus dementiaSCE Neurology

An older adult has cognitive slowing, urinary urgency and a magnetic gait. MRI shows ventriculomegaly disproportionate to sulcal enlargement with tight high-convexity sulci. What is the next management step?

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Correct answer: ASpecialist 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