A 77-year-old woman is brought to the physician for gradually increasing confusion and difficulty walking for the past 4 months. Her daughter is concerned because she has been forgetful and seems to be walking more slowly. She has also had increasingly frequent episodes of urinary incontinence and now wears an adult diaper daily. She has hyperlipidemia and hypertension. Current medications include lisinopril and atorvastatin. She is confused and oriented only to person and place. Neurological examination shows impaired attention and short-term memory. She has a broad-based gait and takes short steps. Laboratory studies are within normal limits. Which of the following is the most likely underlying cause of this patient's urinary incontinence?

Question

Quizplus · Accepted Answer

Eductional Objective: Normal pressure hydrocephalus occurs due to decreased cerebrospinal fluid absorption, resulting in ventriculomegaly with normal intracranial pressure.  This causes stretching of the descending cortical fibers (corona radiata) from the frontal lobe and contributes to the classic triad of symptoms (ie, dementia, gait abnormalities, urinary incontinence).  Loss of cortical inhibition of the sacral micturition center leads to urge incontinence

A 77-Year-Old Woman Is Brought to the Physician for Gradually