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Decreased dopamine synthesis in the substantia nigra on dopamine uptake scan
13%
6/47
Dilated ventricles on MRI
53%
25/47
White matter T2 hyperintensities of the cerebral cortex on MRI
9%
4/47
Minor atrophy of the cerebral cortex on CT
2%
1/47
Severe atrophy of the cerebral cortex on MRI
15%
7/47
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This patient is presenting with symptoms suggestive of normal pressure hydrocephalus (wet, wacky, and wobbly), which is associated with dilated ventricles on MRI.Normal pressure hydrocephalus (NPH) presents with classic symptoms of "wet, wacky, and wobbly," which corresponds to symptoms of urinary incontinence, dementia, and unstable gait. This disease is caused by the accumulation of ventricular fluid that compresses surrounding structures. The outflow of the ventricular system is usually obstructed. The diagnosis can be confirmed with a CT scan or MRI demonstrating dilated ventricles. Treatment is with shunts that remove excessive fluid and pressure.Williams and Malm review the evidence regarding the diagnosis and treatment of normal pressure hydrocephalus. They discuss how this disease will present with dilated ventricles on MRI. They recommend the placement of a shunt in patients with recurrent symptoms.Incorrect Answers:Answer 1: Decreased dopamine synthesis in the substantia nigra on dopamine uptake scan describes Parkinson disease which presents with memory loss and a slow, stooped, and festinating gait. Treatment is with carbidopa and levodopa in order to supplement CNS dopamine.Answer 3: White matter T2 hyperintensities of the cerebral cortex on MRI is a nonspecific finding, but can be seen in cases of vascular dementia, which presents with a step-wise decline in cognitive function. Treatment is with control of underlying risk factors such as hypertension.Answer 4: Minor atrophy of the cerebral cortex on CT describes normal aging which would present with minor forgetfulness without impaired daily function. Treatment is with reassurance and support.Answer 5: Severe atrophy of the cerebral cortex on MRI describes Alzheimer dementia which presents with a gradual decline in cognitive function that eventually is incapacitating. Treatment is with memantine.Bullet Summary:Normal pressure hydrocephalus presents with "wet, wacky, and wobbly," and dilated ventricles on MRI.
5.0
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