Teaching Points:
- Clinical Manifestations of Normal Pressure Hydrocephalus
- Gait Abnormalities
- One of the first clinical signs of NPH
- Occurs early on in the disease
- Typically have “magnetic gait” in which their feet appeared stuck to the ground
- Wide based gait with externally rotated feet
- Most likely to respond to large volume lumbar taps
- Cognitive impairment
- Patients clinically appear more apathetic, similar to a depressed patient
- Urinary incontinence
- Also can occur early on in the disease progression
- Gait Abnormalities
- Diagnosis
- Clinical Manifestations as listed above
- Imaging – MRI Findings
- Presence of ventriculomegaly in the absence of sulcal enlargement.
- Non-obstructing hydrocephalus
- Presence of ventriculomegaly and increased sulcal size suggestive of generalized senile atrophy (hydrocephalus ex vacuo)
- Lumbar Puncture with normal opening pressure
- Other etiologies ruled out with CSF studies
- Spinal Tap Test
- Perform large volume spinal tap (30-50cc CSF drainage)
- Have patient ambulate a certain distance, then turn around and ambulate back, before and after spinal tap test
- Measure changes in mobility, steps, and timing of ambulation, along with MOCA/MMSE
- If lumbar test shows significant improvement, patient is likely to respond to VP shunting.