Lower-body parkinsonism: reconsidering the threshold for external lumbar drainage

Nature Clinical Practice. Neurology
Alberto J EspayGabrielle de Courten-Myers

Abstract

An 80-year-old man with a 60 pack-year smoking habit, hypertension, and hypercholesterolemia presented to a movement disorders clinic with a 30-month history of step-wise progression of gait, balance, and memory impairment. He had experienced multiple falls and two hospitalizations for sudden-onset freezing of gait. Neurological examination, brain MRI, neuropsychological evaluation, gait analysis, continuous external lumbar drainage of cerebrospinal fluid, and post-mortem neuropathological studies. Vascular parkinsonism was diagnosed on the basis of the patient's history and imaging findings; however, post-mortem neuropathology was consistent with a diagnosis of normal pressure hydrocephalus and did not support that of vascular parkinsonism. Ventriculoperitoneal shunt placement superseded tighter control of vascular risk factors, as judged by the patient's response to continuous lumbar drainage.

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Citations

May 19, 2010·Biomarkers in Medicine·Andrew TarnarisLaurence D Watkins
Feb 9, 2010·Revue neurologique·J-P AzulayM Vaugoyeau
May 23, 2015·Movement Disorders : Official Journal of the Movement Disorder Society·Joaquin A VizcarraAlberto J Espay
Apr 29, 2015·Nature Reviews. Neurology·Amos D Korczyn
Jul 12, 2013·Bioscience Reports·Eduardo Nunes ChiniCarlos Escande
Sep 23, 2020·Movement Disorders : Official Journal of the Movement Disorder Society·Alfonso FasanoJoachim K Krauss
Aug 24, 2017·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Claudia GilibertoMario Zappia
Aug 4, 2016·Journal of Clinical Neurology·Kyunghun KangHo Won Lee
Oct 12, 2017·Frontiers in Neurology·Adán Miguel-PugaOscar Arias-Carrión
Jul 3, 2018·Frontiers in Neurology·Giovanni MostileMario Zappia
Oct 21, 2020·Journal of Neurology·Giovanni MostileMario Zappia

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