A case of Parkinsonism

• 65 years old male Mr.Gangaiya from Perambur ,a known case of

Parkinson disease was admitted in RGGGH ,
• C/o Increased slurring of speech and
• Difficulty in walking - 2 days
• H/O PRESENTING ILLNESS:
• Patient was apparently normal 2years back, after which he had
Slurring of speech, Difficulty in walking, Resting tremor, diagnosed as
Parkinson disease
• H/o tremors - 2years
• H/o unstable gait – 2years
• No h/o headache
• No h/o fever
• No h/o seizure
• No h/o blurring of vision
• No h/o trauma
• PAST HISTORY:
• Known case of Hypertension – 2 years
• Not a k/c/o Diabetes Mellitus, Bronchial Asthma, Tuberculosis, Epilepsy.
• TREATMENT HISTORY:
• Tab. Syndopa 110mg TDS
• Tab. Amantadine 100mg BD
• Tab. Trihexyphenidyl 2 mg BD
• Tab. Telmisartan 40mg OD
• On irregular treatment
• PERSONAL HISTORY:
• Mixed diet
• Not a smoker, Not an alcoholic
• Bowel and bladder habits normal
• FAMILY HISTORY:
• No other family members are suffering from similar illness.
• GENERAL EXAMINATION:
• Conscious
• Oriented
• No pallor
• No clubbing
• No cyanosis
• Not icteric
• No pedal edema
• No lymphadenopathy
• Cogwheel rigidity.
• Stooping posture.
• Resting tremor – hands.
• Vitals
• BP : 120/70mmHg
• PR : 86/min
• Spo2 : 98 %
• RR : 14/min
• Systemic examination:
• CVS : S1,S2 heard
• RS : NVBS heard
• P/A : Soft, No organomegaly.

• Power RIGHT LEFT

• UL 5/5 5/5
• LL 5/5 5/5
• Tone RIGHT LEFT
• UL Increased Increased
• LL Increased Increased
• Reflexes RIGHT LEFT
• UL Exaggerated Exaggerated
• LL Exaggerated Exaggerated
• DIAGNOSIS :
• Parkinson disease/Systemic Hypertension
• INVESTIGATIONS :
• Hb : 11.7g/dl
• TLC : 11,400 cells/3mm
• Platelet : 2.53L
• Neut :87%
• Lymph : 9.5%
• RBS : 112mg/dl (100-125)
• Sr.urea : 23mg/dl (15-40)
• Creatinine : 1.1mg/dl (0.5-1.3)
• Total bilirubin : 0.6 mg/dl (0.3-1.3)
• D.Bilirubin : 0.2mg/dl (0.1-0.4)
• SGOT. : 18 IU/L (12-38)
• SGPT. : 28 IU/L (7-41)
• ALP : 79 IU/L (35-130)
• T.Protein : 7.0g/dl (6.5-8)
• Albumin : 4.7g/dl (3.5-5)
• Sodium : 138meq/l(136-146)
• Potassium : 3.8meq/l(3.5-5)
• Calcium : 9.1mg/dl(8.6-10.2)
• Phosphorous : 3.1mg/dl(2.5-4.5)
• ECG
• Normal
• NEUROPHYSICIAN OPINION:
• MRI brain
• Tab. syndopa 110mg 1-1-1
• Tab. Trihexyphenidyl 2mg 1-1-0
• Review with reports.
• Treatment: 04.03.2020 (on admission)
• DIL
• TPR/BP chart
• Tab. Syndopa 110mg 1-1-1
• Tab. Ranitidine 150mg 1-0-1
• Tab. Domperidone 10mg 1-0-1
• On 5/3/2020
• Tab. Syndopa 110mg TDS
• Tab. Ranitidine 150mg BD
• Tab. Domperidone 10mg BD
• On 6/3/2020 (discharge)
• Tab. Syndopa 110mg TDS
• Tab. Trihexyphenidyl 2 mg BD
• Tab. Ranitidine 150mg BD
• Tab. Domperidone 10mg BD
On admission -4/3/2020 5/3/2020 6/3/2020 ( on discharge)

DIL Tab. Syndopa 110mg TDS Tab. Syndopa 110mg TDS

TPR/BP chart Tab. Ranitidine 150mg BD Tab. Trihexyphenidyl 2 mg BD
Tab. Syndopa 110mg 1-1-1 Tab. Domperidone 10mg BD Tab. Ranitidine 150mg BD
Tab. Ranitidine 150mg 1-0-1 Tab. Domperidone 10mg BD
Tab. Domperidone 10mg 1-0-1.