Normal Pressure Hydrocephalus is a clinical condition associated with gait ataxia, dementia and urinary incontinence and pathologically enlarged ventricles with normal opening pressures. The presenting complaints are highly variable and the characteristic triad is not universally seen. Atypical presentation with subtle Parkinsonian features, Huntingdon movement abnormalities and cognitive dysfunction can resemble many other conditions in the elderly. Impact of cognitive dysfunction in our population with people more than 60 years old still economically vulnerable is significant. NPH is one of the few treatable causes of dementia and thus the need for early recognition and management. Little attention has been given to this potentially treatable condition of the elderly in India. This case series study on 50 patients admitted in Govt TDMC, Alappuzha, with majority older than 70 years of age and of both gender was carried out to determine the spectrum of clinical presentation in patients presenting with clinical or imaging studies suggestive of normal pressure hydrocephalus. In our study, despite all having CT brain suggestive of NPH, the characteristic triad was not universal and many had no clinically correlated findings. Atypical presentation with extra-pyramidal features were seen in 25% cases with distal resting tremor and impaired distal fine movements being the most common presentation. Gait abnormality was seen in 40%cases and most had cognitive dysfunction. A strong negative correlation between cognitive behaviour inventory score, UPDRS (Parkinsonism score) and ACE (Cognitive examination score) was found. The study concluded that even though all patients had CT Brain suggestive of NPH, the characteristic triad was not seen in many and extra-pyramidal presentation and cognitive dysfunction could also be considered as an important spectrum of clinical features.

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Dr Rashmi KP

Assistant Professor of Medicine,

Dept of Medicine, Govt T D Medical College, Alappuzha