Question:easy
A patient presents with ataxia, urinary incontinence and dementia. The likely diagnosis is:
A patient presents with ataxia, urinary incontinence and dementia. The likely diagnosis is:
Show Hint
Think wet, wobbly and wacky, a reversible dementia.
Updated On: Jun 24, 2026
- Alzheimer's disease
- Parkinson's disease
- Steele Richardson syndrome
- Normal pressure hydrocephalus
Show Solution
The Correct Option is D
Solution and Explanation
The question hinges on pattern recognition of a well known clinical triad. When ataxia (gait disturbance), urinary incontinence and dementia occur in the same patient, the single unifying diagnosis is Normal Pressure Hydrocephalus.
Think of it as the result of slowly accumulating cerebrospinal fluid in dilated ventricles even though the measured pressure stays near normal. The stretched periventricular fibres that control the legs are affected early, which is why the broad based magnetic gait shows up first. Pressure on frontal pathways then produces the urinary urgency and later the cognitive slowing.
A useful bedside shorthand is $wet + wobbly + wacky$, standing for incontinence, gait trouble and dementia. The importance of recognising it is practical: a ventriculoperitoneal shunt can reverse much of the disability, so it belongs to the short list of treatable dementias.
Quickly eliminating the others: Alzheimer's gives an amnestic dementia without early gait or bladder signs; Parkinson's gives a resting tremor with rigidity and bradykinesia; Steele Richardson (progressive supranuclear palsy) gives vertical gaze paralysis with backward falls. None reproduces the full triad.
\[\boxed{\text{Normal pressure hydrocephalus}}\]
Think of it as the result of slowly accumulating cerebrospinal fluid in dilated ventricles even though the measured pressure stays near normal. The stretched periventricular fibres that control the legs are affected early, which is why the broad based magnetic gait shows up first. Pressure on frontal pathways then produces the urinary urgency and later the cognitive slowing.
A useful bedside shorthand is $wet + wobbly + wacky$, standing for incontinence, gait trouble and dementia. The importance of recognising it is practical: a ventriculoperitoneal shunt can reverse much of the disability, so it belongs to the short list of treatable dementias.
Quickly eliminating the others: Alzheimer's gives an amnestic dementia without early gait or bladder signs; Parkinson's gives a resting tremor with rigidity and bradykinesia; Steele Richardson (progressive supranuclear palsy) gives vertical gaze paralysis with backward falls. None reproduces the full triad.
\[\boxed{\text{Normal pressure hydrocephalus}}\]
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