Parkinson's plus ( PSP - CBS ) , Frontal lobe degeneration

58yr Male retired teacher - Bsvrj

Diagnosis- Parkinson's plus ( PSP- CBS )

                    Frontal lobe degeneration

Reason for Admission - 

Difficulty in speaking since 1year

Difficulty in walking , writing since 6 month's.

Decreased facial expression since 6mnths

HOPI- 

Pt was apparently asymptomatic 1year back during which he was promoted to head master to a new school where he noticed difficulty in speaking i.e he noticed breaking of word's and has to repeat them , initially he thought it was due to his adjustment problem with colleagues but it's gradually progressing & later on 6months ago during his retirement he was unable to sign in bank cheaques & registers. Their family members noticed that he's bending forward in sofa's & his left arm is not swinging while walking & Occasionally shaking of left hand & he's not interacting with them in house & sitting quietly since 6mnths.

He found difficulty in climbing upstairs & doing his routine activities like buttoning shirts ..etc

past History of HTN & on Olmar A 20/5 OD

Initial Diagnosis- Parkinson's Disease

PHYSICAL EXAMINATION-

O/E 

pt- c/c/c

speech- Poverty of word's along with breaking of word's.

MMSE- Normal

Cranial nerves- Occulomotor- Saccades decreased

                            pursuit- Normal, 

                            Vertical Gaze- impaired

Remaining CN- INTACT

Motor system- Increased tone & Brisk DTR

Sensory system- Intact

Cerebellum- No nystagmus, Rhomberg - -ve

LABORATORY DETAILS:-

CBC,RFT,LFT, Electrolyte's - Normal

INVESTIGATIVE PROCEDURES:-

MRI BRAIN - 

Mid brain to pons ratio

SHORT AXIS RATIO

mid brain short axis- 6.6mm ( < 9.35 mm)

pons short axis- 19mm

RATIO- 0.34 (<0.52)

MID BRAIN ATROPHY

AREA RATIO-

mid brain area- 0.8cm2

pons area- 5.8cm2

ratio- 0.14 (<0.16)

Above findings has high sensitivity to PROGRESSIVE SUPRANUCLEAR PALSY

Therapeutic Procedure-

Sydopa challenge test done on 22/05/22- mild improvement is noted mainly in UPDRS scoring

Treatment Given-

1.Inj.HOMIN IV OD

2.Inj.pantop 40mg IV OD

3.Tab.Pinom A 20/5 OD

COUSE IN HOSPITAL-

A 58yr male with complaints of difficulty in speaking, writing, walking, since 6mnths .

ADVISE at Discharge-

1.Tab.LCD 125mg 1 1 1 1 at 8am, 12pm, 4pm, 8pm

 before food

2.T.ALZIL M 5/5 OD 1 0 0 for 15 day's Followed by 

BD 1 0 1 to be continued

3.T.ESTALEVIS 10mg OD 0 0 1 

4.T.COQEEN 100mg OD 1 0 0 

5.T.LIOFEN XL 10mg OD 0 1 0

6.Review after 1month to Neurology OPD

7.Regular yoga & breathing exercises