What finding supports the diagnosis of normal pressure hydrocephalus after CSF removal via lumbar puncture?

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Multiple Choice

What finding supports the diagnosis of normal pressure hydrocephalus after CSF removal via lumbar puncture?

Normal pressure hydrocephalus is suggested when removing CSF leads to rapid clinical improvement, especially in gait. Draining CSF via lumbar puncture can transiently relieve the periventricular stretch and improve frontal-subcortical circuits, so seeing gait and even mental-status improvement within hours after CSF drainage strongly supports the diagnosis. Enlarged ventricles on MRI can occur in NPH but are not diagnostic by themselves. An elevated opening pressure would argue against NPH because the condition typically has normal CSF pressure. Seizures are not a characteristic feature of NPH and would point to other etiologies.

Normal pressure hydrocephalus is suggested when removing CSF leads to rapid clinical improvement, especially in gait. Draining CSF via lumbar puncture can transiently relieve the periventricular stretch and improve frontal-subcortical circuits, so seeing gait and even mental-status improvement within hours after CSF drainage strongly supports the diagnosis.

Enlarged ventricles on MRI can occur in NPH but are not diagnostic by themselves. An elevated opening pressure would argue against NPH because the condition typically has normal CSF pressure. Seizures are not a characteristic feature of NPH and would point to other etiologies.

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