Review Question - QID 107056

This patient's clinical presentation is consistent with normal pressure hydrocephalus (NPH), which can be treated with large-volume lumbar punctures.

NPH is a communicating hydrocephalus whose symptoms can be remembered by the mnemonic "wet, wacky, and wobbly." Patients typically present with urinary incontinence, delirium, and a broad-based, slow gait. Contrary to the name of disease, NPH may present with a slightly elevated CSF opening pressure. Short-term treatment includes large-volume lumbar puncture, but long-term treatment may include placement of a ventriculoperitoneal shunt. Patients typically recover fully after treatment.

Illustration A shows an T2-weighted MRI of a patient with NPH, with noted enlargement of the ventricles.

Incorrect Answers:
Answer 1: Donepezil is an acetylcholinesterase antagonist used to slow the progression of Alzheimer's disease.
Answer 2: Memantine is an NMDA receptor antagonist that is a second-line treatment for Alzheimer's disease.
Answer 4: Carbidopa/Levodopa is used for treatment of Parkinson's disease, which typically presents with rigidity and and shuffling gate before the onset of dementia.
Answer 5: This presentation is not secondary to cerebrovascular dies ease and anticoagulation is not indicated.