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Patient Case Study

The patient was a 69 year old man who started having problems with his balance and walking that started insidiously, but slowly worsened over 1 year. He initially noticed difficulty turning and walking on uneven surfaces, but soon he had difficulty getting out of a chair and needed the assistance of a cane. Despite that, he fell 10 times over course of 6 months. He was seen by numerous physicians and neurologists. He had MRI’s of his entire brain and spine, electrical studies of nerves and muscles, numerous blood tests without reaching a conclusive diagnosis. He even was given a trial of a Parkinson’s  medicine which did not help him much. He had only minor memory complaints. He then started noticing urinary urgency and frank incontinence. His movements were restricted to a wheelchair and walking with the support of his wife and son. They sought a second opinion at our Center. As can be seen for the video when we first presented to us, he had a great difficulty walking and turning despite the use of the cane.

The patient, pre lumbar puncture

After a neurological examination to exclude other potential confounding diseases, a large volume lumbar puncture was recommended. Prior to the lumbar puncture, a baseline assessment of the patient’s gait and balance was performed by multiple tests, including a video.

The patient, post lumbar puncture

During the lumbar puncture 35 ml of CSF was drained. Quantified tests of gait and balance suggested a definite improvement and hence shunt surgery was recommended.

The patient's three year recovery

The patient underwent physical therapy to further improve his balance and gait. At his three-year follow-up appointment, he was walking much better and had no need for a cane, walker or wheelchair.

While he is a representative patient, not everyone improves to the same degree due to several factors including age at diagnosis, co-existing medical conditions, degree of cognitive impairment, degree of improvement after the lumbar puncture or extended CS drainage trial and several other factors.

 

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