Presentation
Vague and disorientated. Unable to follow commands.
Patient Data
Age: 75 years
Gender: Male
From the case:
Normal pressure hydrocephalus
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- large ventricles, more than would be expected for the degree of cerebral volume loss, with narrow callosal angle
- periventricular and deep white matter hypodensity in keeping with chronic small vessel disease
Based on CT findings, normal pressure hydrocephalus was suspected and further characterization on MRI recommended.
From the case:
Normal pressure hydrocephalus
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- 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
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.