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Leslie and Bill, While I am a psychiatrist with PD, not a neurologist and obviously not having seen your mother-in-law I can state some general opinions. I am also forwarding a copy of this letter to Bob Fink who is a neurosurgeon and might be able to speak to some of these issues. It seems highly implausible to me that she suddenly developed Parkinson's Disease. The only way I could justify the diagnosis under the circumstances you cite is if she had slowly been developing symptoms over a period of time and the the fall led to the finding of the slowly developing symptoms. (I doubt it) Especially with the appearance of Normal pressure hydrocephalus and the multiple cerebral infarcts a good case for Parkinsonism secondary to these causes can be made. At least from the information I have the second neurologist makes a lot more sense to me than the first. I do not know whether NPH or multiple infarcts responds to the usual treatments (Like Sinemet) for PD. Maybe Bob can answer that. Did she finally get the shunt? That would be the treatment for NPH. Did she recover spontaneously? How old is She? I would suggest contacting the second neurologist and ask him to put his recommendations in writing. Then have your ATTORNEY call the managed care organization give them his recommendations for care and make it clear that you will hold them responsible for any harm that will come to her as a result of their decisions. On the face of it the second neurologist makes more sense than the first so if you also feel that way you might pay him out of pocket (if you can afford it and then fight the insurance company to reimburse you.) I will not state an opinion on whether she should continue the sinemet. You might contact neurologist #2 for that. Welcome to the wonderful world of managed (and mismanaged) care. Charlie Leslie and Bill wrote: > > Hi everyone, > > This is a quest for information, because we are having problems with > doctors and insurance and usually the people living with the problem > (disease) have the latest information. the information below involves > several diagnosis so you get the whole picture. > > This is the problem - In January, my mother in law was found conscious > but unable to move on the floor in her apartment. Was taken to hospital. > ist diagnosis virus, but was admitted for further test due to inability > to walk, stand or sit. > > within 6 hrs of admission, diagnosis was Parkinsin's disease and > Eldripril and Simimet were started. Diagnosis was made by observation by > the neurologist only - dopamine level was never evaluated. Obviously he > never reviewed the MRI either. > > Two days later the attending physician finally got around to reviewing > chart noted that the MRI showed all venticles in the brain > significantally enlarged with fluid except the 4th venticle with > possible aqueduct stenosis. The MRI showed evidence of previous strokes. > > They planned immediate discharge since the neurologist was too busy for > the procedures to be performed while she was an impateint. Out patient > spinal tap and possible ventricular-peritoneal shunt was supposed to be > scheduled but wasn't scheduled. > > We demanded a second opinion and the 2nd neurologist gave the diagnosis > of normal pressure hydrocephalus and multiple previous strokes. She also > told us that the fluid pressure can cause a parkinson syndrome not > actually parkinson disease. > > They demanded that she be discharged immediatly and we had to take her > home. Nylcare refused a referral to a specialist for the tests. The 1st > neurologist refused to perform the tests since he disagreed with the > diagnosis. > > Since then her primary vare doctor demanded she be on the meds even when > I explained that she had no symptoms- she told me that the symptoms of > Parkinson's disease can come and go and we needed to get her back on the > meds before the symptoms came back. MY QUESTION: DO THE SYMPTOMS OF > PARKINSON'S DISEASE COME AND GO?? > > She was on the meds in the hospital and the attending wrote the wrong > dosage on the discharge prescription - so we was off the meds for 10 > days after discharge with no symptoms!!!!! > > Because her ddoctor demanded, the meds were restarted but no change > noted and her doctor then refused to answer all our phone calls about > medication as well as BP related problems - we decided to stop the meds > - according the the PDR levodopa can cause hypotension and then was > occuring and again Carm has no symptoms. > > any replies welcome > > Leslie and Bill -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************