A 70-year-old female presented with the clinical triad of normal pressure hydrocephalus (NPH) and senile tremor. Neuroimaging disclosed findings of both NPH and empty sella (ES). A ventriculoperitoneal shunt did not modify the clinical course except for a mild and transient improvement, and shunt malfunction occurred later on. The association of NPH and ES may result from a common underlying mechanism such as transient increases in intracranial pressure.