In a case of suspected normal pressure hydrocephalus (NPH), what would CT imaging likely reveal?

In cases of suspected normal pressure hydrocephalus (NPH), CT imaging typically reveals ventricular enlargement without significant cerebral atrophy. NPH is characterized by the classic triad of gait disturbance, urinary incontinence, and cognitive dysfunction, and the distinct finding on neuroimaging is enlarged ventricles despite normal or even slightly elevated intracranial pressure. The enlargement is due to an accumulation of cerebrospinal fluid (CSF) in the ventricles, which occurs in the context of impaired CSF absorption or flow but without the degree of brain shrinkage often observed in other forms of dementia or atrophy.

In contrast, cortical atrophy is more commonly seen in conditions like Alzheimer's disease and is not a typical finding in NPH. Extra-axial hemorrhage would suggest a different pathological process, such as a subdural hematoma, rather than NPH. Multiple ring-enhancing lesions are suggestive of conditions like abscesses or tumors and do not correlate with NPH. Thus, the imaging findings in NPH distinctly focus on the pattern of ventricular enlargement relative to the preservation of surrounding brain tissue.