Table of Contents
Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 3 LBD - Gross Pathology - Pallidotomy and DBS | 4A0 Case 4 History
Case 4 History ---- The patient was a 71yo male with Parkinson's disease and discitis. The patient first noticed a decrease in left arm swing and a decrease in general coordination in playing the drums in 1974. In 1975 he complained of generalized slowing, particularly with writing. He was started on Amantadine in 1975 with some improvement. By 1977 the Amantadine no longer had benefit and he began taking Sinemet because of worsening tremor, rigidity and bradykinesia in his left hand. He lived "a normal life" for the next ten years. He had no cognitive change until 1994 when he had decreased attention span, irritability and low mood. Since 1994 he had episodes of increasing dyskinesia alternating with periods of freezing. He was restless and got up several times per night. He had cramping in his legs. He had increasing problems with his gait and had many falls. He tended to trip over his feet and had particular difficulties with turning. He was thought to have Stage III Parkinsonism with tremor, rigidity, bradykinesia, and postural instability. He had a pallidectomy on the right side performed in May of 1997 with good benefit in terms of decreased dyskinesia, although he had more difficulties with freezing. By August of 2000 he was determined to have Stage IV Parkinsonism with marked tremor, rigidity, partial instability and moderate bradykinesia. Dyskinesia limited his medical management. He had wearing off and period freezing. He was judged to be a candidate for subthalamic nuclear stimulation and bilateral stimulators were placed in November of 2000, apparently with good benefit. In December 2000 he presented to the emergency room with two weeks of severe low back pain and inability to walk secondary to the pain. He underwent a lumbar laminectomy in 1995. A lumbar spine MRI done in December 2000 showed that there was stenosis at L1-L2; and L3-L4; and a wedge compression fracture of L5. On 12-8-00 the patient had a fluoroscopic guided lumbar spine, disc and bone biopsy of L1-L2 disc and the inferior endplate of the L1 bone. His marrow space contained edematous fibrous tissue which and scattered neutrophils, plasma cells and lymphocytes. The patient was noted to have medication-related hallucinations in December 2000. He was noted to have an excellent response to the subthalamic nuclear stimulators with improved mental status and required a decreased Sinemet dose. In late December 2000 he was pronounced dead of multiple trauma as the result of being struck by a motor vehicle.
