Headache

Question 1

What is the classic triad of symptoms of normal pressure hydrocephalus?

Answer 1

1. Gait disturbance
2. Dementia / cognitive impairment
3. Urinary Incontinence

Question 2

Aetiology of normal pressure hydrocpehalus:

Answer 2

50% Primary (usually >60yo)

50% Secondary - due to impaired CSF reabsorption, from damage to the arachnoid villi / granulations:

Intraventricular and/or subarachnoid hemorrhage (either from aneurysm or trauma)

Prior acute or ongoing chronic meningitis (from infection, cancer, or inflammatory disease).

Question 3

Diagnosis of normal pressure hydrocephalus:

Answer 3

MRI better than CT.
Test for other treatable causes (dementia screen).
Neuropsychiatric testing.
Response to removal of CSF.
ICP monitoring, CSF infusion tests, Cisternography.

Question 4

Management of normal pressure hydrocephalus:

Answer 4

Neurosurgical: Ventricular shunting

Regular CSF removal (not studied for efficacy)

Acetazolamide (not studied)