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Today I saw a patient in clinic.80 yr old with GBM ( Braintumor) receiving chemotherapy and also had a stroke with left hemiparesis.Dependent for ADL on family but had O.K kind of quality of life as per family, with KPS of 60 %.She had global decline in her functional status over 5 weeks mainly cognitive and became incontinent.she could not answer most of my questions and could not carry conversation.No fever or signs if infection.Tell me the DDX and what you want do ? This is very interesting case.If some one answers than I will post accordingly
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Good .that is a possibilty but whatelse and if it is NPH what is the next step ?
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High dose steroids and VP Shunt?
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Not yet.anyother thoughts
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O.K.It is a practical sitiuation
DDX:
1.UTI and urosepsis
2.Status epilepticus ( Non convulsive )
3.Leptomeningeal disease
4.GBM getting worse
5.NPH
So I did blood work and UA .She did not have any infection.EEG no seizures.her MRI did not show tumor progression or leptomeningeal disease but does have communicating hydrocephalus.So she is coming for lumbar drain placement tomorrow and if her cognition gets better with lumbar drain after 3 days than I will refer her for VP shunt.
This is good teaching case today to my residents
