3 YEARS AGO MY HUSBAND , 56 YRS OLD STARTED A GAIT PROBLEM WITH ON HIS RIGHT SIDE, HE WAS TOLD HE HAD PARKINSONS. HE WAS PUT ON NUMEROUS PARKINSONS DRUGS WHICH NON OF THEM WORKED, SO ALMOST A YEAR LATER HE WENT IN FOR A NUCLEAR CISTERNOGRAM IT SHOWED THE RATE OF FLOW FROM THE LUMBAR SPINE IS QUITE SLOW, IMPRESSION WAS SLOW FLOW OF THE ISOTOPE WITH DELAYED CLEARING FROM THE SPINE. THE DIRECTION OF FLOW OVER THE VERTEX IS NORMAL AND THEIR IS NO FLOW INTO THE VENTRICLES. IN THE MEAN TIME HE'S STILL TAKING A PARKINSONS DRUG TO GET HIM BY AS THE NEUROLOGIST SUGGESTED TO DO FOR NOW, AFTER ABOUT 3 MONTHS HE WENT IN FOR A SPINAL TAP, REMOVED 16 CC'S AND HE WAS ABLE TO RUN, JUMP, HOPSCOTCH, YOU NAME IT FOR ABOUT 2 HOURS, AFTER THAT HE WAS BACK TO SQUARE ONE, SO THIS TOLD THE DOCTOR HE NEEDED A VP SHUNT, THE FIRST ONE WAS A MEDTRONICS SHUNT, A PROGRAMABLE, WITHIN 3 WEEKS HE WENT THU BEING DIZZY, HEADACHE, SWEATING, BALANCE OFF AGAIN, AND SLOW MOVEMENTS, THE DOCTOR HAD HIM COME INTO SURGERY AGAIN TOOK THAT ONE OUT AND REPLACED IT WITH A LOW PROFILE SHUNT, NON PROGRAMABAL SHUNT . NOT EVEN 24 HOURS AFTER SURGERY, HE WAS ABLE TO WALK SLOWLY, BUT WITH BEING DIZZY AGAIN, YESTERDAY AT THE HOSPITAL HE WAS ABLE TO WALK A LITTLE BETTER, BUT NOT AS DIZZY, COULD YOU PLEASE TELL ME IF THIS SURGERY WAS UNNECESSARY ? MAYBE HE DOES HAVE PARKINSONS ? THE 2 DIFFERENT MRI'S DID NOT SHOW LARGE VENTRICLES AT FIRST UNTIL THE DR. REALLY STUDIED THEM . HE IS OFF OF ALL THE PARKINSON DRUGS NOW FOR 2 WEEKS, AND HE DOES SHAKE A LITTLE, BALANCE IS STILL OFF. HE CAME HOME TODAY FROM THE HOSPITAL WITH THE 2ND NEW SHUNT. SO WE ARE PRAYING THAT THIS ONE WORKS.
I am sorry to hear of the continued health issues being faced by your husband for over three years.
His presentation is a bit atypical for Parkinson's Disease (PD), which initially presents with tremor, slowness, loss of facial expression etc rather than a gait disorder, which typically develops later in the disease course. Also, the MRI may pick up some increased contrast enhancement in a specific region called Substantia Nigra, especially when newer, iron containing contrast agents are used. Also, initial response to medications in a patient with PD is usually quite satisfactory.
Additionally, it is unlikely that a patient with PD would respond dramatically to CSF removal, as your husband did after 16 cc was removed. This suggests that decompression may help him, and your doctor correctly planned a VP shunt placement. It is unfortunate that there was post-surgical complication and shunt failure, which is not uncommon.
Overall, I think that he does have a low-flow non-obstructing hydrocepalus with the resultant gait problem and dizziness. If this shunt is able to decompress the CSF successfully, his symptoms are likely to abate and he will show clinical improvement.
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