Clinical Pearls:  Patients with Normal Pressure Hydrocephalus classically have a wide-based, magnetic gait. 

Normal Pressure Hydrocephalus presents classically with the triad of abnormal gait, dementia, and urinary incontinence.  Gait disturbance is key to diagnosis.  A Parkinsonian gait is classically shuffling on a narrow base, as opposed to the gait of NPH which has a wide base and is often called “magnetic” or “Glued,” as if the patients’ feet were stuck to the floor.  Falls occur commonly on turning, which takes several steps to complete.  Ct demonstrates ventriculomegaly out of proportion to the degree of cortical atrophy but this is a very subjective radiologic call.  High-volume CSF removal will improve gait for those with NPH and help confirm the diagnosis.  Ventriculo-Peritoneal Shunt can be performed but results are variable and with improvement shown mostly in gait, as opposed to dementia.