What is the typical clinical triad for normal pressure hydrocephalus and the treatment approach?

• A. Headache, papilledema, weight gain; treatment is radiotherapy.
• B. Gait disturbance, urinary incontinence, cognitive impairment; treatment is CSF shunting.
• C. Gait disturbance, autonomic dysfunction, short-term memory loss; treatment is diuretics.
• D. Seizures, sensory loss, ataxia; treatment is chemotherapy.

Answer: (B)

Normal pressure hydrocephalus presents with a distinct triad: gait disturbance, cognitive impairment, and urinary incontinence. The gait change is usually a broad-based, slow, magnetic or shuffling walk and often appears first. Cognitive problems resemble a subcortical dementia, with slowed processing and executive dysfunction. Urinary symptoms progress from urgency to incontinence as the condition advances. The underlying issue is impaired CSF absorption leading to ventriculomegaly, even though CSF pressure can read as normal on measurement. The treatment that fits this pattern is CSF diversion to remove excess fluid, most commonly a ventriculoperitoneal shunt, which can reduce ventricular size and improve gait and, to some extent, cognitive function and continence. A CSF tap test may help predict who will respond to shunting. Other approaches like diuretics or oncologic therapies (radiation, chemotherapy) do not address the root problem in NPH and are not standard treatments.