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Normal pressure hydrocephalus — SCE Geriatric Medicine MCQ

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ModerateNeurologyNormal pressure hydrocephalusSCE Geriatric Medicine

An 80-year-old woman has recurrent falls, urinary urgency and progressive gait disturbance over a year. Her family describe apathy and slowed thinking rather than memory loss. Examination shows a broad-based magnetic gait; CT head shows ventriculomegaly out of proportion to cortical atrophy. What is the most likely diagnosis?

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Correct answer: C — Normal pressure hydrocephalus

The triad of gait disturbance, urinary symptoms and cognitive slowing with disproportionate ventriculomegaly suggests normal pressure hydrocephalus. Vascular parkinsonism can cause gait impairment but does not usually produce this imaging pattern. Alzheimer disease tends to present with episodic memory impairment before gait failure. The pearl is that NPH should be considered because selected patients may improve after specialist assessment and CSF diversion.

Reference: JRCPTB geriatric curriculum; NICE dementia differential guidance