Lower-body parkinsonism: reconsidering the threshold for external lumbar drainage.
BACKGROUND
An 80-year-old man with a 60 pack-year smoking habit, hypertension, and hypercholesterolemia presented to a movement disorders clinic with a 30-month history of step-wise progression of gait, balance, and memory impairment. He had experienced multiple falls and two hospitalizations for sudden-onset freezing of gait.


METHODS
Neurological examination, brain MRI, neuropsychological evaluation, gait analysis, continuous external lumbar drainage of cerebrospinal fluid, and post-mortem neuropathological studies.


METHODS
Vascular parkinsonism was diagnosed on the basis of the patient's history and imaging findings; however, post-mortem neuropathology was consistent with a diagnosis of normal pressure hydrocephalus and did not support that of vascular parkinsonism.


METHODS
Ventriculoperitoneal shunt placement superseded tighter control of vascular risk factors, as judged by the patient's response to continuous lumbar drainage.
Espay
Alberto J
AJ
Department of Neurology, University of Cincinnati, 231 Albert Sabin Way, MSB 4503, Cincinnati, OH 45267-0525, USA. alberto.espay@uc.edu
Narayan
Raj K
RK
Duker
Andrew P
AP
Barrett
Edwin T
ET
de Courten-Myers
Gabrielle
G
D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D017809:Fatal Outcome; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000175:diagnosis* / Q000473:pathology