01-24-2009, 08:46 AM
A 70-year-old man comes to clinical attention with progressive memory loss, urinary incontinence, and gait instability. His gait is short-stepped, and he turns very slowly, almost toppling over.
MRI of the brain shows dilatation of the ventricular cavities, while the cerebral cortex appears normal. No infarcts are seen. A biopsy of the frontal cortex demonstrates the absence of neurofibrillary tangles and senile plaques.
The patient undergoes lumbar puncture. Forty cc of fluid are removed. Three hours later the patient is able to walk unassisted, and turns well.
The patient undergoes ventriculoperitoneal shunt placement.
He is discharged 2 days later, his gait and cognition much improved.
The following morning his wife finds him lying in bed, very confused,and complaining of a headache. He is unable to walk.
The surgeon who performed the procedure is concerned that his new symptoms are due to
a. Chemical meningitis
b. Subdural hematoma
c. Epidural hematoma
d. Seizures
e. Bacterial ventriculitis
MRI of the brain shows dilatation of the ventricular cavities, while the cerebral cortex appears normal. No infarcts are seen. A biopsy of the frontal cortex demonstrates the absence of neurofibrillary tangles and senile plaques.
The patient undergoes lumbar puncture. Forty cc of fluid are removed. Three hours later the patient is able to walk unassisted, and turns well.
The patient undergoes ventriculoperitoneal shunt placement.
He is discharged 2 days later, his gait and cognition much improved.
The following morning his wife finds him lying in bed, very confused,and complaining of a headache. He is unable to walk.
The surgeon who performed the procedure is concerned that his new symptoms are due to
a. Chemical meningitis
b. Subdural hematoma
c. Epidural hematoma
d. Seizures
e. Bacterial ventriculitis