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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. |
