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Normal pressure hydrocephalus — DGM MCQ

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HardFallsNormal pressure hydrocephalusDGM

An 80-year-old man has recurrent falls and difficulty turning. His wife reports urinary urgency and mild forgetfulness over 9 months. Examination shows a magnetic gait with normal arm swing, and CT head shows ventriculomegaly out of proportion to sulcal atrophy. What is the most likely diagnosis?

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Correct answer: E — Normal pressure hydrocephalus

Gait disturbance, urinary symptoms, cognitive change and disproportionate ventriculomegaly suggest normal pressure hydrocephalus. Parkinson's disease may cause shuffling but usually has bradykinesia, rigidity or tremor rather than prominent ventriculomegaly. NPH is uncommon but important because selected patients may benefit from specialist assessment.

Reference: NICE NG127