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Normal pressure hydrocephalus — ABIM Board MCQ

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ModerateNeurologyNormal pressure hydrocephalusABIM Board

A 78-year-old has one year of progressive magnetic gait, urinary urgency and cognitive slowing. MRI shows ventriculomegaly out of proportion to cortical atrophy. Which diagnosis best unifies the findings?

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Correct answer: A — Normal-pressure hydrocephalus with gait-predominant presentation

The best answer is “Normal-pressure hydrocephalus with gait-predominant presentation”. The gait-first triad with disproportionate ventriculomegaly is classic for normal-pressure hydrocephalus. Neurodegenerative disease can mimic parts of the syndrome but does not itself explain the imaging pattern. A large-volume lumbar tap or external drainage trial may help predict response to shunting.

Reference: AAN Practice Guideline: Idiopathic Normal Pressure Hydrocephalus: https://pmc.ncbi.nlm.nih.gov/articles/PMC4676757/