A 72-year-old man presents with a 6-month history of progressive gait difficulty described as 'magnetic' gait, urinary urgency, and cognitive decline. MRI shows ventriculomegaly disproportionate to sulcal prominence with an Evans index of 0.35. What is the classic triad of this condition?
- A Gait apraxia, dementia, urinary incontinence ✓
- B Tremor, rigidity, bradykinesia
- C Headache, papilloedema, sixth nerve palsy
- D Vertigo, tinnitus, sensorineural hearing loss
Correct answer: A. Gait apraxia, dementia, urinary incontinence
Explanation
Normal pressure hydrocephalus classically presents with Hakim's triad: gait apraxia (magnetic gait), dementia, and urinary incontinence. The gait disturbance is typically the earliest and most responsive to shunting. Option B describes Parkinson's disease. Option C describes features of raised intracranial pressure. Option D describes Meniere's disease or vestibular schwannoma.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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