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 with disproportionate enlargement of the subarachnoid space laterally, particularly in the Sylvian fissures and insular cisterns.
Sagittal high-resolution T2 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 was seen in the white matter of both cerebral hemispheres suggestive chronic small vessel ischemic change also involving the brain stem.
No lobar or 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. Average stroke volume has been calculated as 170microL which is somewhat elevated.
Features are suggestive of normal pressure hydrocephalus.
This case demonstrates both morphological and CSF flow dynamic features suggestive of normal pressure hydrocephalus, and should respond to CSF diversion.
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