Mr Patrick Drew is a 74 year old man (UR number 452342). He was referred by his GP to the neurology team for investigation and management of his Parkinson’s disease, dysphagia and falls
Signs and symptoms
On assessment he demonstrated bradykinesia, gaze limitations (in all directions) a persistent unilateral tremor in his right arm, and a shuffling gait (with limited arm swing). His limb rigidity is ‘lead pipe rigidity’ but he also has ‘cogwheel rigidity’ in his wrists. His wife Betty, described an increasing frequency in coughing and choking during the meals. His lung fields are clear and there is currently no indication of aspiration pneumonia. Mr Drew has right sided facial bruising, including a large periorbital haematoma, where he fell and hit his head earlier in the week. A CT scan ruled out head injury and the event was classified as unremarkable. His frequency of falls has also increased in the last few months. read on about his admission.
Health history
Mr Drews observations are as follows:
Temp – 36.7 C, HR 64, RR 14, BP 140/82, SpO2 97% RA.
Speech pathology and a barium swallow have been booked. He still requires a falls risk assessment and Waterlow pressure area assessment. He has been taking Sinamet CR (a combination of Levodopa and carbidopa) for three years and, most recently amantadine hasbeen added to his regime.
Case Study 2 – Mr Patrick Drew is a 74 year old man (UR number 452342). He was referred by his GP to the neurology team for investigation and management of his Parkinson’s disease, dysphagia and falls. On assessment he demonstrated bradykinesia, gaze limitations (in all directions) a persistent unilateral tremor in his right arm, and a shuffling gait (with limited arm swing). His limb rigidity is ‘lead pipe rigidity’ but he also has ‘cogwheel rigidity’ in his wrists. Link to Mr Drew Case
Discuss the following in relation to this case:
• Succinctly discuss the underlying pathophysiology in relation to the presenting signs and symptoms of Mr Drew
• Discuss the pharmacological management in relation to symptom relief and ongoing management. Link your discussion to the relevant pathophysiology of the condition.
