American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard treatment for Normal Pressure Hydrocephalus?

1. Diuretics

2. Ventriculoperitoneal shunt placement

3. Cognitive therapy

4. Antiepileptic drugs

The correct answer is: Ventriculoperitoneal shunt placement

The standard treatment for Normal Pressure Hydrocephalus (NPH) is ventriculoperitoneal shunt placement. NPH is characterized by a triad of symptoms: gait disturbance, cognitive dysfunction, and urinary incontinence, and it typically occurs despite normal ventricular size on imaging. The underlying issue in NPH is an imbalance in the production and absorption of cerebrospinal fluid (CSF), leading to the accumulation of fluid in the ventricles. The ventriculoperitoneal shunt works by diverting excess CSF from the ventricles of the brain to the peritoneal cavity, where it can be absorbed by the body. This procedure often leads to significant improvements in symptoms, particularly in gait and cognitive function, and can dramatically enhance the quality of life for affected individuals. Other treatment options, such as diuretics or antiepileptic drugs, do not address the underlying issue of CSF accumulation and are not effective in managing the symptoms of NPH. Cognitive therapy may provide some benefit in terms of supportive care but does not resolve the hydrocephalus itself. Thus, ventriculoperitoneal shunt placement is the definitive and preferred treatment for this condition.