A 63 YEAR OLD MALE WITH MOVEMENT DISORDER

DR.NAVYA(INTERN)

DR.CHETANA(INTERN)

DR.ABDUL RAHEEM (INTERN)

DR.ASHFAQ(INTERN)

DR.SRAVYA(INTERN)

DR.GNANADA(INTERN)

DR.CHARAN(PG1)

DR.VAMSI(PG1)

DR.SUSMITHA(PG2)

DR.ADITHYA (PG3)

DR.PRANEETH(PG3) 

DR.PRAVEEN NAIK (ASS.PROF)

DR.RAKESH BISWAS(HOD)

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Here is a case i have seen:

 A 63 yr old male with 3 year history of movement disorder presented to opd with involuntary rhythmic oscillatory movements of distal left arm and wrist suggestive of tremors which are coarse (3/sec) , large amplitude present at rest and absent on work suggestive of resting tremors 

Pt had similar complaints since 3 years where he was adviced with syndopa 

On further probing pt could recall he had difficulty in climbing upstairs , walking and turning around , reduced arm movement with walking 

He also reports all these symptoms were decreased while he takes tab. Syndopa since 6 months . Pt stopped taking adequate dose of syndopa following Which his symptoms decreased 

All his symptoms are asymmetric , involving only left upper limb 

No autonomic disturbances 

H/O PAST ILLNESS-

K/C/O Parkinson’s since 3 years 

Not a k/c/o HTN, DM, THYROID DISORDERS,CVD,TB, ASTHMA, EPILEPSY.

O/E

Vitals - 

Bp -100/60mmhg

Pr-76bpm

Temp-97.6F

Spo2-96%

CVS-S1,S2 +

RS-BAE+

P/A-

Soft ,non tender

CNS-

Higher mental functions-intact

Cranial nerves intact 

Motor- involuntary rhythmic oscillatory movements of distal left forearm and wrist which are coarse (3/sec) and large amplitude present on rest and absent on work and of pill rolling type

Reflexes-in both limbs

Biceps -2+

Triceps +

Supinator+

Knee+

Ankle+

Sensory system-normal 

Cerebellum signs -absent 

Diagnosis - Parkinson’s disease?

INVESTIGATIONS:

Treatment:

TAB.SYNDOPA 150MG HALF TABLET EVERY 5TH HOURLY.

TAB.ZINCOVIT PO OD