Normal pressure hydrocephalus: treatment seeks disease

If you have been revising for the MRCP, DGM or Geriatric SCE exams recently, then there’s a high chance you will have come across a question much like this.

An 82 year old woman presents with a history of falls over the last six months. During this time period she has developed urinary urgency and incontinence. A gradual reduction in memory has also been noted by her daughter. She was found to have a small stepping gait with difficulty turning round. Only mildly increased tone in both legs is found on neurological examination. She scores 24 out of 30 on the MOCA test.