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Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 3 LBD - Gross Pathology - Pallidotomy and DBS | 5A0 Case 5 History
Case 5 History ---- The patient is a 77yo male with a past medical history significant for Parkinson’s Disease, diabetes mellitus, coronary artery disease, s/p stent, atrial fibrillation, and lung adenocarcinoma. He had small bowel resection for transmural ischemic necrosis in January 2002. In February 2002, he was found unresponsive with respiratory acidosis. He developed RA thrombus and bilateral Pseudomonas and ORSA pneumonia and was transferred to the MICU. By February 2002, he was noted to have disabling dyskinesias and severe motor fluctuations with dose failures and short duration of benefit, treated by subthalamic nucleus (STN) stimulators. However, the next day, he began experiencing visual hallucinations. Stimulator use allowed eventual termination of all medical therapy for PD, but he developed confusion, agitation, irritability, delusions and psychosis. His mental status returned to near baseline at the end of April. His parkinsonian symptoms were dramatically improved with intermittent mild dyskinesias. However, he continued to have intermittent atrial fibrillation and flutter with RVR and hypercapnia. Acute renal insufficiency with hyperkalemia thought secondary to ATN prompted initiation of hemodialysis that continued until 5/22 when his renal insufficiency resolved. On 5/6, he was awake, attentive, and was able to follow commands perfectly and walk 62 feet with assistance. However, on 5/17, he had an episode of jerking movements with decreased consciousness. For the next days, he continued with fluctuating levels of consciousness. On 6/5, he developed an episode of severe hypoglycemia (<30 mg/dL), and had abnormal eye movements, upper extremity stiffening with internal rotation and jerking. Due to his poor prognosis and expressed wishes, mechanical ventilation was withdrawn, and he expired.
