Snapshot A 71-year-old man presents to his neurologist for gait difficulties. He is accompanied by his wife who said that he takes short steps and has had episodes of urinary incontinence. He denies any head trauma or recent infectious symptoms. Physical examination is notable for magnetic gait; however, the rest of the neurological assessment is unremarkable. An MRI brain is performed, which demonstates ventricular enlargement without ischemic changes. He undergoes a large volume lumbar puncture, and 45 minutes after the tap his gait significantly improves. He is referred to neurosurgery for ventricular shunting. Introduction Definition login to view 1 more bullet Associated conditions login to view 2 more bullets Epidemiology Incidence login to view 1 more bullet Etiology Idiopathic Secondary causes include login to view 5 more bullets Pathogenesis Unknown in idiopathic cases In secondary NPH cases login to view 1 more bullet Presentation Symptoms login to view 5 more bullets Physical exam login to view 4 more bullets Imaging MRI brain login to view 5 more bullets Studies High-volume lumbar puncture login to view 1 more bullet Differential Parkinson disease login to view 2 more bullets Vascular dementia login to view 2 more bullets Treatment Operative login to view 3 more bullets Complications Falls