Presentation
An adult male patient presented with altered sensorium, gait problems, and urinary/fecal incontinence.
Patient Data
Dilated lateral and 3rd ventricles associated with transependymal edema. There is prominence of the Sylvian fissures and cisterns, with some crowding of the gyri at the vertex. Bilateral patchy frontal and occipital T2/FLAIR hyperintense areas, likely chronic small vessel ischemic in nature are of an amount commonly seen in this age group.
Temporal horns of lateral ventricles measure 10 mm (normal 6 mm)
Callosal angle 86 degrees ( Normal 100-120 degrees)
The third ventricle measures 19 mm
Case Discussion
The diagnosis of normal pressure hydrocephalus can be challenging and cannot be made on the basis of imaging features alone. In this case, the dilated lateral and 3rd ventricles are associated with transependymal edema, usually not this pronounced in NPH.
The classical clinical findings of normal pressure hydrocephalus are 1-3:
- urinary incontinence
- deterioration in cognition (dementia)
- gait disturbances
- a classic neurological sign in NPH is magnetic gait, where the patients' feet appear to be magnetically attached to the floor
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