A seventy year old man with intractable vomiting, Parkinsonism, memory loss and ptosis

Abstract

Localization of the problem The symptoms in this patient, in the order in which they appeared are: a. Vomiting b. Ataxia and difficulty to turn, c. Parkinsonian tremor, hypophonic dysarthria, and bradykinesia, d. Memory loss, e. Bilateral ptosis, and f. Gaze palsy to left. Since the first four symptoms do not have good localizing value, it is better to see the localization of symptoms e and f mentioned above and to see whether the other symptoms can be explained by a lesion in that vicinity. Parkinsonian symptoms The patient had tremor and cogwheel rigidity of left upper limb, facial hypomimia and slow hesitant gait.A structural or secondary cause of parkinsonism rather than idiopathic parkinsonism should be considered in this patient because of the many associated symptoms and signs. Since the patient has history of antiemetic use, drug-induced parkinsonism may be considered. [...]an attempt should be made to explain all symptoms in a given patient by the same lesion. Since the patient has a progressive illness, it would be worthwhile to consider whether mass lesions can produce parkinsonism.