A hypertensive patient with clinical and laboratory features of normal pressure hydrocephalus (NPH) but with evidence of bilateral multiple cerebral infarcts on computed tomography (CT) did not benefit from shunting. In six reported cases of hypertensive cerebrovascular disease with NPH, the result of shunting was not predictable and was generally disappointing. Laboratory criteria to predict which cases of NPH will benefit from shunting remain controversial. The chances of improvement after shunting are slight when there is CT evidence of bilateral multiple cerebral infarcts, even though other clinical and laboratory data might suggest NPH.