skip to main content

Normal pressure hydrocephalus — MRCPsych Paper A MCQ

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

ModerateNeuroanatomyNormal pressure hydrocephalusMRCPsych Paper A

A 78-year-old man develops a progressive short-stepped gait with difficulty initiating walking, urinary urgency and cognitive slowing with impaired executive function. MRI shows ventriculomegaly disproportionate to cortical sulcal atrophy. Dysfunction of which neural system best accounts for this pattern?

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

Reveal the answer and explanation

Correct answer: E — Periventricular frontal-subcortical pathways

The correct answer is E. The combination of gait-initiation difficulty, urinary urgency, executive slowing and ventriculomegaly disproportionate to sulcal atrophy indicates normal pressure hydrocephalus. Its gait and cognitive manifestations are associated with dysfunction of periventricular frontal-subcortical pathways adjacent to the enlarged ventricles. Medial temporal dysfunction would predominantly cause episodic-memory impairment, as in Alzheimer disease, without explaining the gait–urinary pattern. Dominant temporoparietal disease would cause prominent language disturbance. Anterior visual pathway demyelination would produce visual symptoms, while cerebellar vermian or Purkinje-cell degeneration may cause ataxia but would not account for executive slowing, urinary urgency and disproportionate ventriculomegaly.

Reference: Williams MA, Malm J. Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus. Continuum. 2016;22(2 Dementia):579–599. https://pubmed.ncbi.nlm.nih.gov/27042909/