Question Title: Hydrocephalus, vasculitis- Are these commonly misdiagnosed as Alzheimer's?

: : My mother had a history of rheumatory arthritis with flare-ups after menopause. Ten years ago had bilateral knee replacements. She had also been on triamcinolone tablets for 15 yrs.Four years ago Mom had Breast CA and was treated with Chemo and radiation. Soon after treatments ended she began to develop unexplained gastric problems with no cause found. She also developed extreme weakness in her legs. At the same time her legs would get strange bruising (spots). Mom frequently went to her GP who told her it was all a result of her chemo and steroid use for her arthritis. About a year and a half ago Mom complained about tingling and numbing in her right arm which traveled to her chin and lip and she also complained more frequently of headaches. At the same time she was getting more unsteady in her gait, had more trouble writing, had some trouble with memory and also seemed depressed. Again her GP ordered a cervical x-ray and said it was probably just a slight pinched nerve. He ordered her Zoloft for depression and attributed everything else to her arthritis. Last Spring Mom experienced a delusional episode and dizzy spells with memory loss. A CAT scan was done and her GP said the Ventricles were slightly enlarged and that the only cause he could see was Mom was having symptoms of Alzheimer's. I questioned him and he said that time would tell. In the next three months Mom fell and broke her femur and ribs due to what we think were TIA's and was not able to walk anymore. Her mental status got to a point where whe was completely aphasic and dysphagic. She was also hospitalized three times for fever of unknown origin. She was anemic, had white counts in the mid to high teens, and sed rates ranging from 50's to 90's. Each hospitalization I questioned the doctors and was told mom had Alzheimer's and the all else was due to viremia. I demanded another CAT scan because Mom was almost Comatose. They told me the ventricles were alittle enlarged but Mom had a rapid form of Alzheimers. How could a person deteriorated like this in a matter of a few months from Alzheimers? I finally changed her GP in August. She had an MRI and A spinal tap done and was found to have Normal pressure hyrocephele. She then began to have seizures and was hospitalized in a coma. A whole array of diagnostics was done and she was found to have vasculitis. The physicians were shocked that so many of her symptoms were overlooked before. She had a VP shunt placed and was placed on Decadron for the vasculitis. She regained her complete mental abilities and was rehabbed to perform ADL's and walk with a walker. For two months all was well when she developed an ear infection and pericarditis. Two weeks later she was hospitalized in the local community hospital for sepsis and altered mental status. She experienced pain in her head, hypertension, and had slurred speach and dementia. I again questioned about vasculitis. The neurologist told me NO that it was Alzheimer's and the other symptoms were because of sepsis. I had her discharged when she was stable and her memory returned. Before I could bring her to the physician that treated her previously for the hydrocephele and vasculitis she experienced extreme gastric pain and was again hospitalized for diverticulitis and a perforated colon. She had a colon resection done and coded twice in PACU due atension pneumo and the second time because of a percardial effusion and cardiac tamponade. She remained on a vent for three weeks and only partly regained consciousness before succombing to respiratory failure. I guess why I am writing you with all this is that I wanted to know if this is common for people with vasculitis to be misdiagnosed with Alzheimers? I am appalled at what occurred with Mom because I questioned so many times and several physicians including neurologists told me I was in denial and should adjust to Mom's condition. What I was told by the specialist who cared for Mom in the Fall was that if her vasculitis was caught earlier she would have had a better chance for survival or at least more quality of life and less suffering. By the time he diagnosed her she had so much systemic problems her body was basically falling apart. I guess I need some closure to this very tragic occurrence of the last year and a half.

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: Dear Karen:

: I am so sorry that you and your family had to go through the medical problems that you went through, and even more so of the pain and suffering you mother went through before she died. I really can not comment on what happened. It is easy to cast blame on someone else and their seemingly mis-management of a medical condition. But, I was not there. Please, I am not trying to give an excuse for the management of your mother. I hope and pray that this doesn't happen to someone else or someone's parent or child.

: I really feel like this happens more often when physician's try to manage problems outside their expertise. Sometimes it is managed care that put the pressure on the family physician to manage a patient that he/she should not be managing. Sometimes it is this horrible ego that we physician's sometimes have and we try and play God and think we know it all. I wish it didn't happen, in either of the cases.

: As I was reading your description I was saying to myself that things were not making sense and why were they not doing this or that, and why didn't they think of....

: For my part, I hope your moving account will keep fostering in me that I do not know it all, and that if I do not know something, I need to tell my patient that I don't know.

: May your heart be big and soft, while your skin be thick to walk the path of life after you have seen and felt the horror of mistakes.

: Sincerely,

: CCF Neuro[P] MD

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To the dear MD who followed up on my question: Thank you so much for your compassion and humility. My mom was only 68 yrs. old when she passed away on Feb. 7th and until a few years ago was vibrant and active despite her arthritis. What impressed me the most was even though she endured such extreme hardship she took her illness with such grace, never ever complaining. She put alot of trust in her physician as I think most of us do. I know many mistakes were made. It was so terribly painful to watch her suffer. But with the grace of God we learn and go on. We know that with Man there will be mistakes. It is a good thing that with God all will be made perfect. May God grant you wisdom and knowledge to continue to help those in need. You are admirable for staying true to your oath " to do no harm." Thank you again.

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Dear Karen:

I do not give life, I do not induce death. I am just a vessel who follows the true great physician.

Thank you so much for your thoughts and your love for your mother.

Sincerely,

CCF Neuro[P] MD

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