For no reason, walking instability, what disease are you considering?

Today's case comes from Zhongshan Hospital Neurology, let's take a look at it,patient68-year-old male, high school education, six months ago without obvious incentives to walk unstable, slow pace, wide base, posture instability and easy to fall, get up difficult, need many efforts to stand up from the seat, with memory loss, to near memory-based, symptoms to aggravateIt has previously denied that high blood pressure,diabetesand other cardiovascularvascular diseaseshigh risk factorsMMSE scored 18 points, and no other positive signs were found in the nervous systemThe symmetry of the skull MRI system expanded, the ventricular multiple spot flaky ischemia, and 3D-FIESTA did not see significant obstructionadmission, the patient's gait is characterized by difficulty getting up, slow walking, small step, low lift, unstable swing, feet wider, swing arm symmetry existshead MRI shows traffic hydrocephalus, with the Evans index at 0.31Waist wear measured cerebrospinal fluid pressure 140 mm water column, slow discharge about 30 ml, 72 hours after the patient's gait significantly improvedAfter 72 hours ofdischarge test, the patient's getting up difficulty improved significantly and the walking speed increased fasterfurther exclude other secondary hydrocephalus causes,diagnosis for iexclusivenormal cranial hydrocephalus, ventricular-abdominal shunt After surgery follow-up patients recovered well, walking speed faster than before, the pace of the previous increase, no fall again, sit down after a successful stand 1 month after ventricular-abdominal shunt surgery, the patient recovered well, the pace increased faster than before, the step was larger than before, the stability of the torso was enhanced, and no fall was repeated the normal cranial pressure hydrocephalus the abnormal normal cranial pressure hydrocephalus (iNPH) is one of the causes of reversible gait disorder, clinical manifestations of gait disorder, cognitive impairment and urinary asomic, imaging visible symmetry ventricle enlargement, and cerebrospinal fluid pressure is normal Surgical treatment can reverse the clinical symptoms of the disease The symptoms of iNPH are easily confused with other geriatric degenerative diseases and vascular diseases, often leading to misdiagnosis and misdiagnosis iNPH patient imaging is characterized by the expansion of the symmetrical ventricle, the Evans index (the maximum distance between the front corners of the two sides of the ventricle and the maximum cranial ratio of the same plane) is greater than 0.3, some patients in the coronal level can see DESH signs (side cleavage pool above and the mid-line side of the subcranial cavity narrow, side cleavage and the celiac brain gestonic brain cell widening) the cranial MRI indicates deSH it is believed that the pathogenesis of iNPH is an imbalance between the production and absorption of cerebrospinal fluid, in the traditional cerebrospinal fluid circulation pathway assessment method, the traditional nuclide ventricular imaging, CT and MRI ventricular contrast agent imaging and intracranial pressure monitoring methods such as large damage, poor consistency, diagnostic value is not high, clinically difficult to apply the existence of conventional MRI in the fine anatomical structure of the ventricle system when the spatial resolution is low, inter-plane volume effect, cerebrospinal fluid and surrounding tissue signal is relatively low, vulnerable to cerebrospinal fluid flow signal interference and other shortcomings, the current combination of a variety of MRI sequences in iNPH has a wide range of prospects and clinical application value, such as 2D-PC cine sequence can show the flow rhythm of cerebrospinal fluid and determine cerebrospinal fluid Flow and flow rate, it is helpful to explore the characteristics of iNPH characteristic cerebrospinal fluid dynamics, 3D-FIESTA, 3D-CISS, 3D-SPACE sequence can provide a thin-layer image of high signal-to-noise ratio, in the high-signal cerebrospinal fluid contrast, clearly show the obstruction of the cerebrospinal fluid path, providing the basis for the identification and diagnosis of iNPH Hu Fan Tang Yumin Source: of a Brain Intelligence Platform in The Sun-Yuan