Table of Contents
Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 3 LBD - Gross Pathology - Pallidotomy and DBS | 6A0 Case 6 History
Case 6 History ---- The patient was a 77yo male with a history of CHF, CAD, lymphopenia and thrombocytopenia, and a previous history of MI who developed right sided predominant resting tremor, bradykinesia, freezing, absence of postural reflexes, and mild chorea in 1995. Mental status at that time was normal. His disease continued to progress and he began experiencing increased rigidity resulting in speech impairment. Treatment was complicated by orthostasis and development of peak-dose dystonias. He underwent a pallidotomy in November of 1996 with some improvement, but by 2001 was essentially bedridden secondary to severe rigidity. Bilateral STN DBS placement was performed in July of 2001, with improvement of his rigidity and bradykinesia, however his condition continued to decline. He developed bulbar dystonias resulting in recurrent aspiration pneumonias, and by 2002 he was dependent upon G- and J- tubes for medication administration and feeding. He also began to demonstrate confusion and disorientation, which was felt to be at least partially due to medication effect. In July 2003 respiratory distress resulted from aspiration pneumonia. At that time he was oriented only to name. According to his wishes he received comfort measures only and was transferred to hospice in August 2003, dying shortly thereafter. The total course of his PD was 8 years.
