Falls, broad based gait, incontinence (545/1700)

545. A 73yo male presents with a 12m hx of falls. His relatives have also noticed rather strange
behavior of late and more recently he has had episodes of enuresis. Exam: disorientation to
time and place, broad-based, clumsy gait. What is the most probable dx?

a. Dementia
b. Pituitary adenoma
c. CVD
d. Syringomyelia
e. Normal pressure hydrocephalus


































answer: E
• acute hydrocephalus

• signs and symptoms of acute elevated ICP
• impaired upward gaze (“sunset eyes”) and/or CN VI palsy

• chronic/gradual onset hydrocephalus (i.e. NPH)
gradual onset of classic triad developing over weeks or months

1. pressure of ventricle on lower extremity motor fibers > gait disturbance (ataxia and apraxia usually initial symptoms)
2. pressure on cortical bowel/bladder center > urinary incontinence
3. pressure on frontal lobes > dementia