QuestionSBA
QuestionChoice
AN MRI scan of the head would not be the most appropriate investigation in normal pressure hydrocephalus, as it can be diagnosed more easily using a CT scan. MRI would, however, also be diagnostic for NPH, and may also demonstrate ventriculomegaly and deep white matter ischaemia.
10006899
d
Urine culture
QuestionChoice
This patient is presenting with features typical of normal pressure hydrocephalus (NPH). A patient will typically have the triad of gait disturbance, cognitive impairment, and incontinence. A CT scan of the head is the most appropriate investigation, demonstrating hydrocephalus with dilated ventricles in the absence of sulcal enlargement. This condition is typically managed using a ventriculoperitoneal (VPL) shunt.
10006896
a
CT head
QuestionChoice
AN MRI scan of the head would not be the most appropriate investigation in normal pressure hydrocephalus, as it can be diagnosed more easily using a CT scan. MRI would, however, also be diagnostic for NPH, and may also demonstrate ventriculomegaly and deep white matter ischaemia.
10006897
b
MRI head
QuestionChoice
Nerve conduction studies would not aid a diagnosis of normal pressure hydrocephalus. It may be used to help diagnose Guillain-Barre syndrome.
10006900
e
Nerve conduction studies
QuestionChoice
A lumbar puncture may be a useful investigation for ruling out differential diagnoses, and a large volume lumbar puncture can be used to see if the removal of CSF results in an improvement of symptoms. It would not typically be used on its own to diagnose normal pressure hydrocephalus.
10006898
c
Lumbar puncture
Concept
Chapter
2693
4550
Normal pressure hydrocephalus
Topic
141
Neurology
CT head
13926
A 74-year-old male presents to A&E with his wife following a fall the day before. On questioning, the wife revealed that he has had several minor falls over the past four months and has become progressively more unsteady on his feet. The patient's wife also explained that he has had three events of faecal and urinary incontinence at home, and that he has been increasingly confused recently. 
The patient's observations are stable and within normal ranges, and the gait is observed to be shuffling. A neurological examination is normal. Initial blood tests are normal.

Which of the following investigations would be most appropriate to confirm the likely diagnosis?
a