A 64-year-old woman is evaluated for progressive gait disturbance over the last 2 years. The patient feels her feet are "stuck on the floor" and that she is unsteady while walking. She also recently began experiencing urinary urgency and has wet herself several times due to difficulty getting to the bathroom on time. The patient stopped working 6 months ago because of difficulty concentrating, and she has also lost interest in her hobbies and social activities. She has had no tremor, visual changes, headaches, nausea, or vomiting. The patient has a remote history of closed traumatic brain injury. Vital signs are within normal limits. On physical examination, lower extremity tone and deep tendon reflexes are increased. Sensation to light touch, pain, and vibration are normal. The patient's gait is slow with small steps and a wide base. CT scan of the head is shown below.

Which of the following is the most likely diagnosis?
A)Alzheimer disease
B)Frontotemporal dementia
C)Idiopathic Parkinson disease
D)Major depressive disorder
E)Normal pressure hydrocephalus
F)Obstructive hydrocephalus
G)Vitamin B₁₂ deficiency

Further Evaluation of the Patient Reveals Microscopic Hematuria

Multiple Choice

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