Topic: Normal Pressure Hydrocephalus
Subject: Medicine
An 81-year-old female is brought to your office by her son. He reports a decrease in his mothers memory and prolonged delays in her responses to questions. She also has developed urinary incontinence. MRI shows dilated ventricles, but no other pathology, and a lumbar puncture reveals a normal opening pressure.
Which one of the following would provide additional evidence of normal pressure hydrocephalus?

Gait instability (sometimes referred to as apraxia of gait), urinary incontinence, and dementia are typical signs and symptoms of normal pressure hydrocephalus (NPH). A decrease in the absorption of cerebrospinal fluid (CSF) results in ventricular enlargement, but no significant increase in CSF pressure. Although it accounts for less than 5% of dementia cases, it is important to recognize NPH because it may be effectively treated by shunting in some patients. Monocular visual loss and headache are symptoms of benign intracranial hypertension (pseudotumor cerebri), and internuclear ophthalmoplegia is a sign of multiple sclerosis. Motor weakness is not a sign of NPH.