Case history
Case history
A 69-year-old man presents with a 1-year history of mild slowness and loss of dexterity. His handwriting has become smaller, and his wife feels his face is less expressive and his voice softer. Over the last few months he has developed a subtle tremor in the right hand, noted while watching television. His symptoms developed insidiously but have mildly progressed. He has no other medical history, but he has noted some mild depression and constipation over the last 2 years. His examination demonstrates hypophonia, masked facies, decreased blink rate, micrographia, and mild right-sided bradykinesia and rigidity. An intermittent right upper extremity resting tremor is noted while he is walking. The rest of his examination and a brain magnetic resonance imaging are normal.
Other presentations
PD can present in myriad ways. The cardinal features of the presence of bradykinesia with at least one of rest tremor or rigidity can occur in various combinations and sequences during the course of the disease. The signs and symptoms are typically asymmetrical. Bradykinesia and rigidity often present in subtle fashion early in the disease course. For example, reduced arm swing, shuffling gait, softened voice, decreased blink rate, decreased facial expressivity, and reduced spontaneous movement are all signs of parkinsonism. The non-motor symptoms of PD, such as depression, anxiety, fatigue, autonomic dysfunction (e.g., orthostatic hypotension, constipation, incontinence, dysphagia), and sleep disorders, may precede the evolution of motor symptoms. Given their non-specificity, however, their relationship to PD is only made after motor symptoms/signs have been identified.
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