The differential diagnosis of normal pressure hydrocephalus

Daniele Rigamonti, Marianne Juhler, Carsten Wikkelsø

Research output: Chapter in Book/Report/Conference proceedingChapter


Hakim and colleagues, in their paper describing the syndrome of normal pressure hydrocephalus (NPH) in three patients, recapitulated the clinical presentation as follows: “a mild impairment of memory, slowness and paucity of thought and action, unsteadiness of gait and unwitting urination” (Hakim’s triad) [1]. They also highlighted two important features of the syndrome: “The symptomatology was unobtrusive, having no assignable date of onset, and evolved over a period of weeks and few months … The most striking feature of the condition was the rapid restitution of the patient’s health as the result of lowering of the cerebrospinal-fluid pressure through surgical shunting.” They further stressed that because “the clinical picture corresponds essentially to that of a mild form of dementia,” it was obligatory for the treating physician to distinguish such a mild dementia “occurring without obvious cause in a middle-aged person … from the large number of dementing illnesses of the presenium and the senium.” Interestingly, pneumo-encephalography demonstrated, in all three cases described in the original paper by Hakim, an obstruction to the CSF, due to a blockage of the subarachnoid space (SAS) at the cervical-medullary junction in the first two cases and to a colloid cyst in the third [1].

Original languageEnglish (US)
Title of host publicationAdult Hydrocephalus
PublisherCambridge University Press
Number of pages11
ISBN (Electronic)9781139382816
ISBN (Print)9781107031777
StatePublished - Jan 1 2012

ASJC Scopus subject areas

  • Medicine(all)


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