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Dr. Ali Al-Bayyati and Dr. Munir Elias

 
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03-FEBRUARY-2012  JEHAD MUHAMED YOUSEF  64 YEARS  NORMAL PRESSURE HYDROCEPHALUS WITH PARKINSONIAN MANIFESTATIONS.


Video unavailable.
The patient was operated at Al-Hayat hospital by the request of the hospital staff and the doctor.
 

Anamnesis

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The patient is a doctor came to the clinic 30-January-2012 complaining of shuffling gait with tremor, for what he was diagnosed as Parkinsonian and was treated accordingly. The patient did not improve and change therapy did not provide any benefit.

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MRI of the brain performed 12-July-2011 showing severely dilated ventricle with subependymal reaction holding suspicion about normal pressure hydrocephalus (NPH).

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Lumbar puncture was done was done 1 month ago, after what he got dramatic improvement for 5 days. Lumbar puncture repeated 2 days ago after what considerable improvement took place.

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On examination, the patient has shuffling gait with urgency and frequency for 2 months. In Romberg position, the patient is swaying with tendency to fall anterior. Cough-wheel rigidity was noticed in the lower limbs. There is intension tremor both hands.

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MRI of the brain was repeated with full protocol with contrast and with MRA and MRV of the brain to rule out any abnormality of the aqueduct of Sylvius.  It confirmed the diagnosis of NPH.

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Lumbo-peritoneal shunt inserted, after what right inguinal hernia repair with mesh was done.

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Routine closure of the wounds. Smooth postoperative recovery.


 

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Comments

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Normal pressure hydrocephalus (NPH) can cause all the clinical manifestations of the patient, but association with Parkinson's disease is still a possibility.

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Postoperative course will tell the impact of the NPH in his clinical signs as the causative role.


 

 

 

 

 


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