DEMENTIA-NORMAL PRESSURE HYDROCEPHALUS

SUMMARY

1. Reversible cause of dementia characterised by communicating hydrocephalus & no cerebral atrophy.

2. NPH often occurs after head trauma, meningitis, or SAH and a history of 1 of these premorbid conditions appears to be the best predictor of a beneficial response to shunting.

3. Normal ICP & no papilledema. Presents with classic Hakim's triad: progressive dementia, urinary incontinence, gait ataxia ("magnetic" gait, with the feet appearing glued to the floor).

4. Investigations to identify response to shunting: response to LP, isotope cystemography, and dynamic MRI, which measures the direction of CSF flow (but none of these tests is universally reliable).

5. Treatment: VP shunt insertion.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].