Two Years of Deteriorating Symptoms with No Diagnosis Found
* Female, 84 years old, 5 feet tall, approximately 160 pounds, Caucasian, does not consume alcohol, previously smoked (quit over 30 years ago). * Medical history includes a successfully removed brain tumor in her 20s, stage 1 bladder cancer successfully treated in her 60s, and a hip replacement about 15 years ago, during which a tendon was inadvertently cut, leading to ongoing pain and the need for a cane. Additionally, she has wet age-related macular degeneration. * Current unresolved health issues include: * Significant balance issues * A stiff or "frozen" walking pattern * Occasional urinary incontinence Before these new symptoms emerged, my mother maintained her well-being. Nevertheless, in recent years, her stability has dramatically declined, leaving her unable to walk unassisted. She has experienced multiple falls in the last two months. Despite consulting with neurologists, physiatrists, and attending physical therapy, there has been no clarity or improvement in her condition. A recent glimmer of hope came from considering normal pressure hydrocephalus as a diagnosis, but the cerebrospinal fluid test returned normal results. Notably, she has not exhibited any signs of cognitive decline. What might be the cause of her symptoms?
Answers (1)
2/12/2026, 3:40:35 PM
OpenHealth AI
It sounds like your mother is experiencing complex symptoms that have significantly affected her mobility and quality of life. Given her age and medical history, especially with prior neurological involvement, it's understandable that finding a clear diagnosis can be frustrating.
Main Points:
- Her symptoms could be multifactorial, potentially involving neurological, orthopedic, or even vascular issues.
- It's important to focus on symptom management and consider further investigation if needed.
Explanation:
The combination of significant balance issues, a "frozen" gait, and urinary incontinence in an elderly individual can arise from various causes, including:
- Neurological Conditions: Even though normal pressure hydrocephalus (NPH) was ruled out, conditions like Parkinsonism or other atypical parkinsonian syndromes could contribute to her symptoms, particularly the stiffness and balance issues.
- Musculoskeletal Factors: Her history of hip replacement and ongoing pain may also complicate her physical condition. Chronic pain can affect mobility and lead to adaptations that may worsen balance.
- Vascular Issues: Reduced blood flow to the brain or multiple small strokes (often referred to as vascular dementia) could cause similar symptoms without initially affecting cognition.
- General Deconditioning: Longstanding issues with mobility, combined with aging, could lead to overall weakness.
Next Steps:
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Focus on Rehabilitation: Continue with physical therapy, emphasizing balance exercises and strength training. Ask her therapist to explore adaptive strategies for mobility that may help her regain confidence.
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Regular Balanced Nutrition: Ensuring she has a nutrient-rich diet can improve strength and overall health, potentially aiding her recovery.
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Evaluate Medications: Review any current medications with her healthcare provider to identify any that may affect balance or movement.
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Consider Comprehensive Neurophysiological Evaluation: If symptoms persist and remain unclear, seeking a more comprehensive assessment from a neurologist who specializes in movement disorders may be beneficial, including advanced imaging if not already done.
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Continuous Monitoring: Observe changes in her symptoms and document them, especially any new or worsening concerning signs.
While it can be disheartening not to have clear answers, maintaining an open dialogue with her healthcare providers and focusing on symptom management can greatly influence her quality of life and well-being. Remember, it's vital to advocate for her needs and explore every avenue for care.
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