Normal pressure hydrocephalus
Functional decline secondary to gait disturbance, shuffling with mild Parkinsonism. Urinary incontinence and cognitive decline.
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The ventricles are prominent, and the sulci are effaced superiorly towards the vertex. The sylvian fissures are quite prominent. Sagittal high-resolution T2 (Yester) demonstrate a widely patent aqueduct, with a very prominent flow void seen on axial T2 imaging, the signal loss filling the 3rd and 4th ventricles.
Patchy T2 hyperintensity seen in the white matter of both cerebral hemispheres suggestive chronic small vessel ischaemic change also involving the brain stem. No evidence of haemorrhage. No lobe are all regional atrophy to suggest a specific underlying neurodegenerative condition. The midbrain does not appear particularly reduced in volume.
CSF flow studies demonstrate prominent flow in the aqueduct. Stroke volume has been calculated as 170microL which is markedly elevated.
Features are consistent with normal pressure hydrocephalus. No convincing features of progressive supranuclear palsy.
This case demonstrates both morphological and CSF flow dynamic evidence of normal pressure hydrocephalus, and should respond to CSF diversion.