American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of gait is typically seen with Normal Pressure Hydrocephalus?

1. Narrow-based gait

2. Wide-based gait

3. Shuffling gait

4. Ataxic gait

The correct answer is: Wide-based gait

Normal Pressure Hydrocephalus (NPH) typically presents with a wide-based gait, which is characterized by the patient walking with their feet spaced further apart than normal. This type of gait occurs due to the underlying mechanisms affecting balance and coordination in patients with NPH, specifically as a result of the increased pressure within the ventricles of the brain, even if this pressure is considered "normal." The wide-based gait is an adaptive mechanism that patients adopt to help stabilize themselves, as they may experience difficulty in maintaining balance due to the neurological deficits associated with the condition. This can lead to a tendency to fall when walking, further incentivizing the individual to widen their stance for better stability. In addition, the gait disturbance often has a distinct "magnetic" quality, where the feet seem to stick to the ground, contributing to the overall difficulty in mobility. Understanding the characteristics of gait in NPH is crucial for diagnosis and management, as it can help differentiate NPH from other disorders that may present with similar features, such as Parkinson's disease or other gait disturbances.