Normal pressure hydrocephalus

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Dementia with gait disturbances.

Patient Data

Age: 80 years
Gender: Male
mri
This study is a stack
Axial
T1
This study is a stack
Sagittal
T1
This study is a stack
Coronal
T1
This study is a stack
Axial
FLAIR
This study is a stack
Coronal
T2
This study is a stack
Axial
Gradient Echo
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Info

The MRI sequences demonstrate:

  • dilatation of the third and lateral ventricles with

    • upward bowing of the corpus callosum 

    • increased Evans index (0.36)

    • acute callosal angle (52°)

  • disproportionate enlargement of the subarachnoid space with

    • enlarged Sylvian fissures

    • narrow sulci and subarachnoid spaces at the vertex and parafalcine region

  • patchy FLAIR and T2 hyperintensities periventricular the white matter, subcortical region and centra semiovale suggestive chronic small vessel ischaemic change.

Annotated image
Evans
index
Callosal
angle
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Info

Annotated images:

  • Evans index = 0.36

  • callosal angle = 53°

Case Discussion

The clinical presentation and the MRI features are most consistent with a normal pressure hydrocephalus.

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