Normal pressure hydrocephalus

Case contributed by Dr Matthew Lukies

Presentation

Vague and disorientated. Unable to follow commands.

Patient Data

Age: 75 years
Gender: Male
CT
  • large ventricles, more than would be expected for the degree of cerebral volume loss
  • periventricular and deep white matter hypodensity in keeping with chronic small vessel disease
  • periventricular hypodensity particularly around the bilateral anterior horns of the lateral ventricles suggestive of transependymal oedema

Based on CT findings, normal pressure hydrocephalus was suspected and further characterisation on MRI recommended.

MRI
  • large ventricles, more than expected for the degree of cerebral volume loss
  • periventricular and deep white matter T2 hyperintensity, in keeping with chronic small vessel disease
  • periventricular T2 hyperintensity particularly around the bilateral anterior horns of the lateral ventricles, suggestive of transependymal oedema

MRI findings are most consistent with normal pressure hydrocephalus.

Case Discussion

Opening pressure on lumbar puncture was normal and the patient improved clinically (MMSE and walk test) after removal of approximately 30 mL of CSF, confirming the diagnosis of normal pressure hydrocephalus.

The patient then proceeded to have a CSF shunt inserted, with further clinical improvement.

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Case information

rID: 54711
Case created: 25th Jul 2017
Last edited: 25th Jul 2017
Inclusion in quiz mode: Included

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