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Normal pressure hydrocephalus — RCPSC IM MCQ

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HardNeurologyNormal pressure hydrocephalusRCPSC IM

A 78-year-old has gait freezing, urinary urgency and cognitive decline with ventriculomegaly disproportionate to atrophy. What test best predicts whether shunting may improve function?

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Correct answer: D — Perform large-volume lumbar puncture with gait testing

The best answer is “Perform large-volume lumbar puncture with gait testing”. A CSF tap test with objective gait assessment can support shunt responsiveness in suspected normal-pressure hydrocephalus. The competing tests do not assess CSF-dynamic reversibility. Objective gait timing before and after drainage is more informative than subjective global improvement and supports multidisciplinary shunt selection.

Reference: Canadian Stroke Best Practices, acute ischemic stroke treatment: https://www.strokebestpractices.ca/recommendations/acute-stroke-management/acute-ischemic-stroke-treatment