Judge Jerry consults a neurologist because his handwriting begins to deteriorate. Stress and exercise makes this condition worse; alcohol makes this tremor less severe. He also notes a side-to-side head shaking. He has no difficulty walking and has no cognitive impairment. His mother had been diagnosed as having "Parkinsonism" five years ago. He had used Haldol for 6 months one year ago to help him sleep, but has stopped this medication with no change in shaking.
Exam - MS - mini -mental
status score is 28 of 30.
gait
- normal base and station
nl
postural stability
motor
- no drift
nl
RAM & RSM, normal tone
reflexes
- symmetrical; plantar flexor response
sensory
- diminished VS at toes
CN
- nl eye movements, nl gag & palate; negative glabellar tap
| Sample of PATIENT handwriting: |  |
| Drawing of PATIENT spiral |  |
| Drawing of DR. WEISBERG'S Arichimedes spiral |  |
- What is the diagnosis?
- What medications may treat this?
- What medication should be avoided?
- What diagnostic tests are necessary to establish the diagnosis?
- What are clinical criteria
to establish diagnosis of Parkinsonism?
- Outline treatment strategy for Parkinsonism.
- What is the most common cause of Parkinsonism?
- Delineate the clinical features of Huntington disease.
- Define:
dyskinesias
dystonia
asterixis
chorea
tremor
myoclonus
fasciculations
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Nothing with this case - Revised 6/21/2005