The triad of normal-pressure hydrocephalus, parkinsonism, and primary empty sella appeared in a 70-year-old woman. There was dramatic resolution of the extrapyramidal signs and symptoms on treatment with levodopa-carbidopa and ventriculojugular shunt. The syndrome may be the result of several mechanisms, but an alteration of cerebrospinal fluid (CSF) pressure dynamics may be the sole etiology for this triad.