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06-OCTOBER-2019 MUHAMED ABDEL-WAHED AHMAD DAYS 82
YEARS RESIDUAL AFTER SHUNTING FOR NPH 5 YEARS AGO AND MALFUNCTIONING AFTER
INFARCTION OF THE RIGHT PARIETAL LOBE 40 DAYS AGO.
Anamnesis
The patient was operated by me for NPH
07-December-2014. The patient was doing OK
until he progressed infarction of the right
parietal lobe 21-August-2019 with gross left
hemiplegia and hemihypalgesia. The shunt was
functioning and the patient recovered slowly.
MRI of the brain done 28-August-2019 and
repeated 14-September-2019 confirming the
infraction. The patient the last week start to
deteriorate dramatically for what he was
hospitalized 05-September-2019.
On examination: The patient is in obtundation
with left sided hemiparesis. CT-scan
chesto-abdomeno-pelvis were normal. MRI of the
brain showed considerable widening of the
ventricular system, mostly due to malfunctioning
shunt be debris of the infarction which shrunken
dramatically.
Exposure the proximal ventricular
part of the shunt and the distal abdominal part. No
apparent debris were seen, but the shunt was
functioning minimally with one 2 drops per minute
with vigorous compression of the valve chamber. A
low pressure VPS Medtronic was replaced and it was
working properly.
Smooth postoperative recovery. He was sent to the ward.
The patient after 3 hours is responding with
reduction of speech with low tone.
Comments
The shunt during infarction was
functioning, but several weeks later the debris of the
infarction occluded the shunt. The location of the debris
was not identified, nor in the reservoir, nor in the distal
part.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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Leica HM500
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