Clinical Reasoning: A 69-Year-Old Female Patient With Rapid-Onset Levodopa-Responsive Rest Tremor, Parkinsonism, and Gait Freezing.
Matthew J Georgiades, Paloma I Becker San Martin, Niroshan Jeyakumar et al.
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Case in brief
A 69-year-old woman developed a unilateral resting tremor that rapidly spread to the opposite arm and then the legs. Within 3 months, she had generalized parkinsonism, a shuffling gait with prominent freezing, and frequent falls. The tremor improved with levodopa, but her other symptoms did not. History, examination, and investigations revealed atypical features that led to a conclusive diagnosis, although the abstract does not specify that diagnosis.
What made this case unusual
The rapid progression from unilateral tremor to generalized parkinsonism with prominent gait freezing and falls, alongside a selective levodopa response, made the presentation diagnostically challenging.
Diagnostic / clinical pearl
Rapidly progressive parkinsonism with gait freezing and a partial levodopa response warrants careful assessment for atypical features and a broad diagnostic evaluation.