Question

A patient presents with ataxia, urinary incontinence and dementia. The likely diagnosis is:

• A. Alzheimer's disease
• B. Parkinson's disease
• C. Steele Richardson syndrome
• D. Normal pressure hydrocephalus

Hint:

Think wet, wobbly and wacky, a reversible dementia.

Answer 1

The Correct Option is D

Step 1: Spot the triad. The patient has three findings together: gait ataxia, urinary incontinence and dementia. This is the classic clinical triad of Normal Pressure Hydrocephalus (NPH).
Step 2: Recall the memory aid. NPH is remembered as "wet, wobbly and wacky" which maps to incontinence (wet), gait disturbance (wobbly) and dementia (wacky). The gait problem usually appears first and is the most responsive to treatment.
Step 3: Understand the mechanism. In NPH the ventricles enlarge with normal or only intermittently raised CSF pressure, due to impaired CSF absorption. Imaging shows ventriculomegaly out of proportion to cortical atrophy. It can improve with a ventriculoperitoneal shunt, so it is one of the few "reversible" dementias.
Step 4: Rule out the distractors. Alzheimer's disease causes progressive memory loss but not early gait ataxia or incontinence. Parkinson's disease causes tremor, rigidity and bradykinesia, not this triad. Steele Richardson syndrome (progressive supranuclear palsy) causes vertical gaze palsy and falls, not the wet-wobbly-wacky triad.
Conclusion: The diagnosis is Normal pressure hydrocephalus, option D.