title: Lower-body parkinsonism: reconsidering the threshold for external lumbar drainage.
abstract: 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  Ventriculoperitoneal shunt placement superseded tighter control of vascular risk factors, as judged by the patient's response to continuous lumbar drainage.
authors.affiliation: Department of Neurology, University of Cincinnati, 231 Albert Sabin Way, MSB 4503, Cincinnati, OH 45267-0525, USA. alberto.espay@uc.edu
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
authors.forename: Raj K
authors.initials: RK
authors.lastname: Narayan
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Duker
authors.forename: Edwin T
authors.initials: ET
authors.lastname: Barrett
authors.forename: Gabrielle
authors.initials: G
authors.lastname: de Courten-Myers
mesh_terms: 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