Idiopathic disease of the elderly, possibly due to decreased brain elastance

Clinical features

Hakim's triad

• Dementia: often manifests as global cognitive impairment, with attention and memory disturbances.
• Magnetic gait: characterized by difficulty in lifting the feet off the floor, appearing as if they are ‘stuck’
• Incontinence: primarily urinary incontinence, but faecal incontinence can also occur

Investigations

• CT/MR imaging: typically show dilated lateral ventricles and absent sulci
  • Dilated lateral ventricles although can also be seen in other forms of dementia due to global cortical atrophy
• Lumbar puncture: measurement of walking ability and cognitive assessment pre- and post-lumbar puncture can help ascertain which patients could benefit from further surgical management

Management

• Therapeutic lumbar puncture: this procedure can alleviate symptoms and improve cognition and walking ability by removing CSF
• Ventriculoperitoneal shunt: in patients responsive to lumbar puncture, neurosurgery may insert a shunt to permanently redirect the excess CSF from the brain to the abdomen