Clinical Features

NPH occurs in individuals 60 to 70 years of age or older. The clinical criteria include the triad of progressive gait disorder, often the presenting symptom; dementia; and urinary incontinence. The gait disorder manifests with short shuffling steps and postural instability (frontal gait apraxia). The dementia has components of frontal lobe dysfunction: psychomotor slowing, loss of initiative, and apathy. Spasticity in the legs and the appearance of Babinski sign may develop due to stretching of the descending corticospinal fibers around the anterior horns. The clinical diagnosis is supported by magnetic resonance imaging (MRI), which shows markedly enlarged ventricles and a normal or variably obliterated subarachnoid space (Fig. 2.21). NPH is one of the few treatable causes of dementias, provided it is diagnosed early. The removal of a large quantity of CSF by lumbar puncture usually improves the gait. The improvement is considered a good prognostic sign and an indication for shunting the CSF from the lateral ventricle to the jugular vein or peritoneal cavity.

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