Chief Complaint
Rule out Parkinson 's disease.
History
The patient is a 64-year-old right-handed white female who presents with her daughter for evaluation of several symptoms. These include balance problems and a tendency to fall backwards, change in her voice and micrographia. They are wondering whether or not she has Parkinson 's disease. She stated that her voice went first about two years ago. She notes that it is getting a little lower, [____]and softer. It is not persistently hypophonic. It waxes and wanes. Her sister recently had problems with laryngeal cancer, but she had a negative workup for that. That has been pretty stable. At times, she can speak normally, and then at the end of a sentence she may be whispering, but then she can immediately increase her voice volume. Her balance is off. She has a wide-based gait. She states she feels dizziness, as if her eyes are lagging behind. She tends to fall to the right or backwards. There is no spinning sensation with this. She does not have it while sitting or rolling over in bed. It is more like a lightheadedness than a vertigo. She notes that she has problems maintaining her balance in the shower and when she closes her eyes. She has …show more content…
She does have some Parkinsonian type features, but it is mostly her balance that I am concerned about. She does have evidence for a sensory or sensory motor neuropathy with decreased sensation in the stocking distribution and a sensory ataxia as identified by her furniture surfing and feeling more secure while walking holding onto a cart. She also has increased reflexes, suggestive of myelopathy. I do not think that we are looking at a complicated process here such as multisystem atrophy with parkinsonism and myelopathy. I think she may have just diabetic peripheral neuropathy and maybe she is anxious or she could actually have a bona fide cervical
Rule out Parkinson 's disease.
History
The patient is a 64-year-old right-handed white female who presents with her daughter for evaluation of several symptoms. These include balance problems and a tendency to fall backwards, change in her voice and micrographia. They are wondering whether or not she has Parkinson 's disease. She stated that her voice went first about two years ago. She notes that it is getting a little lower, [____]and softer. It is not persistently hypophonic. It waxes and wanes. Her sister recently had problems with laryngeal cancer, but she had a negative workup for that. That has been pretty stable. At times, she can speak normally, and then at the end of a sentence she may be whispering, but then she can immediately increase her voice volume. Her balance is off. She has a wide-based gait. She states she feels dizziness, as if her eyes are lagging behind. She tends to fall to the right or backwards. There is no spinning sensation with this. She does not have it while sitting or rolling over in bed. It is more like a lightheadedness than a vertigo. She notes that she has problems maintaining her balance in the shower and when she closes her eyes. She has …show more content…
She does have some Parkinsonian type features, but it is mostly her balance that I am concerned about. She does have evidence for a sensory or sensory motor neuropathy with decreased sensation in the stocking distribution and a sensory ataxia as identified by her furniture surfing and feeling more secure while walking holding onto a cart. She also has increased reflexes, suggestive of myelopathy. I do not think that we are looking at a complicated process here such as multisystem atrophy with parkinsonism and myelopathy. I think she may have just diabetic peripheral neuropathy and maybe she is anxious or she could actually have a bona fide cervical