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Washington University Experience | NEURODEGENERATION | Progressive Supranuclear Palsy (PSP) | 1A0 Case 1 History
Case 1 History ---- This patient was a 69yo male with a history of melanoma of the right chest wall (1986), epithelioid melanoma of the right shoulder (2003), colon cancer status post radiation and colostomy (7/2011); hypertension, sleep apnea, and left, then right, knee replacements in 2009 and 2010. Following falls in August 2011, he was diagnosed with Parkinson disease. Treatment with Sinemet and Azilect reportedly had little effect. In November 2012, he presented with increased instability and cognitive problems with short term memory. Neurological examination in January 2012 found the patient to be very unsteady, unable to tandem walk, afraid of falling, and with left gaze nystagmus. Gait and arm swing were normal; resting tremor and bradykinesia were absent; and extraocular movements were full. A ventriculoperitoneal shunt was placed in January 2013 for possible normal pressure hydrocephalus (NPH). The shunt was tapered with time. In March 2013, the patient presented to an ED with altered mental status. A UTI was discovered and he was admitted for a course of IV antibiotics; however, he did not improve. CT showed intraventricular blood (R>L) treated with an external ventricular drain, subsequently weaned, and then removed. However, his neurological status did not improve. He decompensated rapidly on and died in April 2013.
