Conclusion and Results:
Due to dramatic response to lumbar tap test, the patient would be a good
candidate of surgery for ventriculoperitoneal or ventriculoatrial shunt
insertion. However, we refuse the referral of patient for shunt
insertion after considering prominent comorbidity and negotiation with
family members. In addition, the significant improvement after removal
of CSF helped us to give the decision of serial lumbar tap as the
subsequent treatment procedure. The third lumbar tap performed on 21
January 2020. The family members reported significant improvement in
daily activities after each episode of lumbar tap.
At February 2020, we encounter with the emergence of COVID-19 pandemic.
Consequently, the serial lumber taps were stopped temporarily. Although
the gait deteriorated gradually again, but the situation was not ideal
for performing new lumbar tap.
On the last days of March 2020, an interesting event occurred. The
patient had several sudden sneezing which result in spontaneous CSF
rhinorrhea with the amount of approximately 30 to 40 ml CSF. With
respect to the reports of family members, this event led to significant
improvement in gait and cognition, described as a “miracle” and lasted
for about 3 months. Afterwards, the symptoms were returned gradually
that he could not walk independently.