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05-AUGUST-2009  ZUHAYER RASHEED ABDEL-MAJEED  67 YEARS  NORMAL PRESSURE HYDROCEPHALUS WITH ACOUSTIC SCHWANNOMA LEFT SIDE.

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

Anamnesis:

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The patient came to the clinic 02-August-2009 complaining of tinnitus left ear with loss of hearing left side. The patient also got memory disturbances for 2 months and inability to walk or set with signs of dementia. He could walk with the help of two persons with shuffling gait and he has aphonia. There is mild left sided paresis. There is no nystagmus, nor cerebellar signs. The patient is right handed.

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MRI of the brain performed 23-July-2009 showing medium sized acoustic schwannoma with left intracannalicular extension not causing shift of the brain stem nor the aqueduct of Sylvius.

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The patient was treated initially for Parkinson disease, but he dramatically deteriorated, for what the concerned medications were stopped.

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The patient was considered to have normal pressure hydrocephalus (NPH) for what VPS was considered.

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1-level performance delta medtronic vetriculo-peritoneal shunt adult size was inserted to the right side. During that biopsy was performed with the CSF sent for histopathologic investigations to rule out other encephalopathies.

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Routine closure of the wounds and smooth postoperative recovery.


Comments

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This case is interesting in the prospect, that several pathologies having place at the same time. The dilatation of the left internal meatus, indicate that the schwannoma having place for several years and since the patient has at the present time having memory disturbances and dementia, it hard to tell when he got hearing loss which could be for several years.

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The volume of the tumor cannot explain the wide-spread involvement of the brain and the brain stem dysfunctions.

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Even normal pressure hydrocephalus cannot explain the aphonia, but it is more convincing to explain most of his problems.


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