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Normal pressure hydrocephalus — SCE Neurology MCQ

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HardCognitive NeurologyNormal pressure hydrocephalusSCE Neurology

A patient has progressive magnetic gait, urinary urgency and cognitive slowing. MRI shows ventriculomegaly with tight high-convexity sulci and enlarged Sylvian fissures. Which investigation best predicts whether CSF diversion may improve gait?

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Correct answer: ALarge-volume CSF tap test with objective gait reassessment

The best answer is “Large-volume CSF tap test with objective gait reassessment”. A large-volume tap test assesses short-term objective gait response to CSF removal; a positive response supports shunt benefit, while a negative result has imperfect sensitivity and may prompt extended drainage in selected patients. “Routine EEG before and after photic stimulation” is less appropriate because EEG does not test CSF-responsive gait physiology “Temporal-artery biopsy with histological assessment” is less appropriate because arterial biopsy addresses vasculitis rather than communicating hydrocephalus “Serum anti-GAD antibody testing with titre interpretation” is less appropriate because anti-GAD antibodies do not evaluate ventriculomegaly “Carotid Doppler with extracranial flow-velocity assessment” is less appropriate because carotid imaging cannot predict a CSF-diversion response

Reference: Normal pressure hydrocephalus: diagnosis and management. https://pn.bmj.com/content/23/1/15