difficulty in walking     2  ½ yrs

     memory loss           2  ½ yrs

     urinary problem          2 1/2 yrs


Progressive difficulty in walking and stiffness in upper and lower limbs.

Progressive dementia

Progressive loss of awareness of bladder fullness and control with urinary urgency

Differentials:

?Neurodegenerative disease
?Cerebral inflammatory disease
?Vascular disease
?Metabolic cause
?Miscellaneous

On examination
BUILT- Avg                      
.temperature- 98.6f 
PULSE-86/min        
BP-140/90 mm of Hg
PALLOR-absent                       
ICTERUS-Absent
LYMPHADENOPATHY-Absent
EDEMA-Absent on feet and sacrum
JVP- Normal

CNS:

HIGHER MENTAL FUNCTION-Patient is conscious and oriented to person place and time and has power to recall and retain his past experiences with slight delay grossly impaired in attention, lack of inability in solving problem . Patient has normal speech as they. No history of hallucination& delusion. MMSE is 15/30

                   CRANIAL NERVE EXAMINATION

 1CN olfactory.n- sense of smell is normal in each nostril material used is cardamom

2CN OPTIC.n- visual field ?normal for both eyes

                         colour vision-normal for both eyes

                         visual acuity ? normal for both eyes
3.CN (3,4,6)-This cranial nerves help in the external movement of eye ball.this is also normal in this patient
4.CN(5)- mixed nerve normal  in this patient
5.CN(7)- Normal in this patient
6. CN(8)-Normal in this patient
7. CN(9,10)-
8.CN(11)- Normal in this patient
9 CN(12)- Normal in this patient

Motor:

Nutrition-
                        Right                       left
 upper limb    20cm                    20cm

Lower limb    32cm                     32cm

TONE-
                          Right                 Left
Upper limb      hypertonia           hypertonia

Lower limb      hypertonia          hypertonia

POWER-
                         Right                   Left
Upper limb     grade 5             grade 5

Lower limb     grade 5           grade 5


Gait- slow steps (See Video below):

 http://www.youtube.com/watch?v=xcHm5P6Ndy0
 
MRI images attached:

UDHC email-network Processing:

From: Paritosh Pandey, Prof Neurosurgery, NIMHANS, Bangalore Date: Mon, Sep 9, 2013 at 12:52 PM
There is a strong possibility of NPH. The next step would be to do a lumbar tap test (do a drainage Lumbar puncture and see for improvement). If he improves, a shunt is warranted. 

From: Dr.Nitin Garg Consultant Neurosurgeon, BMHRC, BhopalDate: Sun, Sep 8, 2013 at 11:03 PMSorry for delay in reply. I saw it just now. The images sent are showing only infratentorial region which shows prominent 4th ventricle and prominent b/l temporal horns. I need to see some more images.