Normal pressure hydrocephalus

Case contributed by Bruno Di Muzio
Diagnosis probable


Gait disturbance characterized by feet seeming to be attached to the floor ("magnetic gait"). Mild cognitive impairment.

Patient Data

Age: 80 years
Gender: Female

MRI Brain


Technique: Multiplanar and multisequence images were obtained through the brain, without contrast administration. 

Findings: Multiple T2/FLAIR hyperintensities foci somehow confluent, are present scattered through the subcortical and periventricular white-matter which likely represent chronic small vessel ischemia prominent in severity for this age. 

Mild brain atrophy, without lobar distribution. The lateral and third ventricles are dilated compared to the sulcal pattern and the corpus callosum is displaced upward. The callosal angle is reduced to values between 50-80 degrees. 

There is an extra-axial calcification in the left parietal region, non-specific.

The remainder exam is unremarkable. 

Conclusion: The findings are in keeping with normal pressure hydrocephalus. 

Case Discussion

Normal pressure hydrocephalus is still a quite controversial condition, but in cases like this one, where there are clinical symptoms and signs associated with typical imaging features, the diagnosis can be made with security and treatment may be proposed depending on the other prognostic factors. 

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