Normal pressure hydrocephalus

Case contributed by Dr Ahmed A. Khawwam


Deterioration of mental functions.

Patient Data

Age: 70 years
Gender: Female

Ventriculomegaly evidenced by increased Evans index (> 0.3), widening of temporal horns of lateral ventricles (6 mm).

Acute callosal angle measured at the level of posterior commissure. 

Dilated sylvian fissures with relatively compact narrow sulci at vertex.

Cingulate sulcus sign is noticed in sagittal section.

No obstructive lesion.

Annotated image

Axial image demonstrates Evan`s index = 0.39.

Coronal image demonstrates callosal angle = 76.5°.

Sagittal image demonstrates cingulate sulcus sign.

Case Discussion

The patient presented with deterioration in mental functions. After reviewing imaging study direct questions about urinary incontinence and gait disturbance were asked. Relatives of the patient admitted a recent history of urinary incontinence and gait disturbance in addition to cognitive malfunction.

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