Normal Pressure Hydrocephalus (NPH) : MRI

 History:

A 55 years female presented with dementia and gait imbalance

Findings:

There is ventricular dilatation, dysproportionate to the cerebral atrophy. No significant periventricular ooze. Bowing of the corpus callosum. A classical T2 hypointense jet at 4th ventricle. Features are characteristic of normal pressure hydrocephalus (NPH)

Diagnosis:

Normal Pressure Hydrocephalus (NPH)

Extra Edge

Classical clinical triad?

Dementia, ataxia, urinary incontinence. 

The most characteristic MRI sign?

T2 hypointense jet at 4th ventricle

Which special MRI study is helpful and how?

CSF flow study. To predict success of shunt procedure. If flow across 4th ventricle is more than 42 microlitre/min then shunt may be performed