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### Selected Images
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*Sagittal T1 MR shows large lateral ventricles <img src='/img/arrows/CS.png'/>, thinning of the corpus callosum <img src='/img/arrows/CC.png'/>, and a relatively normal 4th ventricle <img src='/img/arrows/CO.png'/> in a patient with iNPH.*
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*Sagittal T1 MR shows large lateral ventricles <img src='img/arrows/CS.png'/>, thinning of the corpus callosum <img src='img/arrows/CC.png'/>, and a relatively normal 4th ventricle <img src='img/arrows/CO.png'/> in a patient with iNPH.*
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*Sagittal T1 MR shows large lateral ventricles <img src='/img/arrows/CS.png'/>, thinning of the corpus callosum <img src='/img/arrows/CC.png'/>, and a relatively normal 4th ventricle <img src='/img/arrows/CO.png'/> in a patient with iNPH.*
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*Sagittal T1 MR shows large lateral ventricles <img src='img/arrows/CS.png'/>, thinning of the corpus callosum <img src='img/arrows/CC.png'/>, and a relatively normal 4th ventricle <img src='img/arrows/CO.png'/> in a patient with iNPH.*
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*Axial CECT demonstrates typical findings suggestive of iNPH. There is enlargement of the lateral ventricles and sylvian fissures <img src='/img/arrows/CS.png'/> out of proportion to the amount of general sulcal enlargement. The frontal horns show a characteristic rounded appearance. Periventricular hypodensities <img src='/img/arrows/CO.png'/> could reflect interstitial migration of CSF.*
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*Axial CECT demonstrates typical findings suggestive of iNPH. There is enlargement of the lateral ventricles and sylvian fissures <img src='img/arrows/CS.png'/> out of proportion to the amount of general sulcal enlargement. The frontal horns show a characteristic rounded appearance. Periventricular hypodensities <img src='img/arrows/CO.png'/> could reflect interstitial migration of CSF.*
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*Axial T2 MR in a patient with NPH demonstrates lateral ventricular enlargement and disproportionately enlarged sylvian fissure <img src='/img/arrows/CC.png'/> (DESH). Evans index, which is the ratio of the maximum width of the frontal horns to the maximum internal diameter of the skull at the same level, measures 0.38. Normal Evans index is < 0.3.*
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*Axial T2 MR in a patient with NPH demonstrates lateral ventricular enlargement and disproportionately enlarged sylvian fissure <img src='img/arrows/CC.png'/> (DESH). Evans index, which is the ratio of the maximum width of the frontal horns to the maximum internal diameter of the skull at the same level, measures 0.38. Normal Evans index is < 0.3.*
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*Coronal T2 MR in a patient with NPH shows reduced callosal angle (71°). The callosal angle is measured at the level of the posterior commissure and a normal value is between 100-120°.*
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*Sagittal T1 MR demonstrates the cingulate sulcus sign in a patient with NPH with narrowing of the posterior 1/2 of the cingulate sulcus <img src='/img/arrows/CC.png'/> as compared with the anterior <img src='/img/arrows/CS.png'/>.*
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*Sagittal T1 MR demonstrates the cingulate sulcus sign in a patient with NPH with narrowing of the posterior 1/2 of the cingulate sulcus <img src='img/arrows/CC.png'/> as compared with the anterior <img src='img/arrows/CS.png'/>.*
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*Axial FLAIR MR in the same patient demonstrates disproportionately enlarged subarachnoid spaces <img src='/img/arrows/CC.png'/>, consistent with DESH, and narrowing of the sulci and subarachnoid spaces <img src='/img/arrows/CS.png'/> over the high convexity parasagittal frontoparietal regions with a tight interhemispheric fissure <img src='/img/arrows/CO.png'/>.*
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*Axial FLAIR MR in the same patient demonstrates disproportionately enlarged subarachnoid spaces <img src='img/arrows/CC.png'/>, consistent with DESH, and narrowing of the sulci and subarachnoid spaces <img src='img/arrows/CS.png'/> over the high convexity parasagittal frontoparietal regions with a tight interhemispheric fissure <img src='img/arrows/CO.png'/>.*
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*Sagittal T1 MR in a patient with NPH demonstrates focal bulging of the roof of the lateral ventricles <img src='/img/arrows/CC.png'/>, which has been recently described.*
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*Sagittal T1 MR in a patient with NPH demonstrates focal bulging of the roof of the lateral ventricles <img src='img/arrows/CC.png'/>, which has been recently described.*
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*Twenty-four hour multiplanar In-111 DTPA cisternography in a patient with NPH shows radiotracer in the lateral ventricles <img src='/img/arrows/CC.png'/> with lack of activity over the convexity <img src='/img/arrows/CS.png'/>. Normally, there should be radiotracer movement over the convexities at 24 hours. (Courtesy C. Singh, MD and A. Ali, MD.)*
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*Twenty-four hour multiplanar In-111 DTPA cisternography in a patient with NPH shows radiotracer in the lateral ventricles <img src='img/arrows/CC.png'/> with lack of activity over the convexity <img src='img/arrows/CS.png'/>. Normally, there should be radiotracer movement over the convexities at 24 hours. (Courtesy C. Singh, MD and A. Ali, MD.)*
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*Axial T2 MR in 65 year old with NPH shows dilated temporal horns <img src='/img/arrows/CC.png'/> and low-signal flow void <img src='/img/arrows/CS.png'/> in the aqueduct caused by hyperdynamic flow of CSF.*
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*Axial T2 MR in 65 year old with NPH shows dilated temporal horns <img src='img/arrows/CC.png'/> and low-signal flow void <img src='img/arrows/CS.png'/> in the aqueduct caused by hyperdynamic flow of CSF.*
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*Axial phase-contrast cine MR CSF flow study shows increased velocity of CSF through the dilated aqueduct <img src='/img/arrows/CO.png'/>. There is more hyperdynamic flow through the aqueduct than the cisterns, where no high-velocity signal change is seen. Flow is incidentally noted in the posterior cerebral arteries <img src='/img/arrows/CS.png'/>.*
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*Axial phase-contrast cine MR CSF flow study shows increased velocity of CSF through the dilated aqueduct <img src='img/arrows/CO.png'/>. There is more hyperdynamic flow through the aqueduct than the cisterns, where no high-velocity signal change is seen. Flow is incidentally noted in the posterior cerebral arteries <img src='img/arrows/CS.png'/>.*
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### Additional Images
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*Axial T2WI MR shows ventriculomegaly.*
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*Sagittal T1WI MR in the same patient shows an accentuated aqueductal flow void <img src='/img/arrows/BS.png'/>.*
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*Sagittal T1WI MR in the same patient shows an accentuated aqueductal flow void <img src='img/arrows/BS.png'/>.*
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*Axial T2WI MR shows enlarged ventricles with rounded frontal horns.*
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*Axial CECT in the same patient shows symmetric dilatation of the ventricles and sylvian fissures out of proportion to sulcal enlargement. Frontal and occipital periventricular hypodensities are also present.*
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*Axial T2WI MR shows a typical case of normal pressure hydrocephalus. There is enlargement of the lateral ventricles <img src='/img/arrows/WS.png'/> with no sulcal enlargement. The frontal horns <img src='/img/arrows/WC.png'/> show a typical rounded configuration.*
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*Axial T2WI MR shows a typical case of normal pressure hydrocephalus. There is enlargement of the lateral ventricles <img src='img/arrows/WS.png'/> with no sulcal enlargement. The frontal horns <img src='img/arrows/WC.png'/> show a typical rounded configuration.*
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*Axial T2WI MR shows dilated temporal horns <img src='/img/arrows/WC.png'/> out of proportion to the sulcal prominence. Notice the low-signal flow void <img src='/img/arrows/WS.png'/> in the aqueduct caused by hyperdynamic flow of CSF.*
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*Axial T2WI MR shows dilated temporal horns <img src='img/arrows/WC.png'/> out of proportion to the sulcal prominence. Notice the low-signal flow void <img src='img/arrows/WS.png'/> in the aqueduct caused by hyperdynamic flow of CSF.*
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*Sagittal T1WI MR shows enlargement of the 3rd and lateral ventricles. The infundibular recess <img src='/img/arrows/WS.png'/> is enlarged and bulges downward. Note mild thinning of the corpus callosum <img src='/img/arrows/WO.png'/>.*
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*Sagittal T1WI MR shows enlargement of the 3rd and lateral ventricles. The infundibular recess <img src='img/arrows/WS.png'/> is enlarged and bulges downward. Note mild thinning of the corpus callosum <img src='img/arrows/WO.png'/>.*
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*Axial FLAIR MR shows enlarged ventricles <img src='/img/arrows/BS.png'/> out of proportion to the sulcal enlargement. Notice that periventricular hyperintensity is also present <img src='/img/arrows/CS.png'/>.*
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*Axial FLAIR MR shows enlarged ventricles <img src='img/arrows/BS.png'/> out of proportion to the sulcal enlargement. Notice that periventricular hyperintensity is also present <img src='img/arrows/CS.png'/>.*
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*Axial T2WI MR in the same patient shows dilated ventricles. Normal pressure hydrocephalus accounts for ~ 5-6% of all dementias. The classic Hakim triad of dementia, gait apraxia, and urinary incontinence is present in a minority of patients.*
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*Axial NECT shows large ventricles out of proportion to the sulcal prominence with a rounded appearance of the frontal horns <img src='/img/arrows/CO.png'/>.*
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*Axial NECT shows large ventricles out of proportion to the sulcal prominence with a rounded appearance of the frontal horns <img src='img/arrows/CO.png'/>.*
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*Axial T2WI MR in the same patient shows ventriculomegaly. The patient presented with the classic clinical triad of NPH: Dementia, gait apraxia, and urinary incontinence. One treatment option is ventricular shunting. The response to shunting is variable.*
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