Session Title: Phenomenology and Clinical Assessment of Movement Disorders
Session Time: 1:15pm-2:45pm
Location: Les Muses Terrace, Level 3
Objective: Our main objective is to illustrate different etiologies for paresthesia and gait impairment that can occur in a patient with Parkinson disease. We present the case of a 60-year-old Caucasian man with advanced Parkinson’s disease in treatment with levodopa-carbidopa intestinal gel infusion (LCIG), that came to our hospital at his last 6 month follow up complaining of paresthesia at his lower limbs and gait impairment.
Background: Parkinson’s disease (PD) is a long-term degenerative disorder of the central nervous system, that affects predominately dopamine-producing neurons and can generate both motor and non-motor symptoms.
Method: The clinical examination revealed anesthesia for vibratory and mioartrokinetic sense in both of his lower limbs. Regarding BP, he had short episodes of bradykinesia and dystonia in off with a UPDRS score of 37 point in on. The paraclinic tests performed to determine the etiology of paresthesia consisted in blood tests, cerebral CT scan, EMG and lombar IRM. Because the blood concentration of vitamin B12 was low we tested the antibodies against parietal cell and intrinsec factor that excluded Biermann anemia and performed an EMG that showed a moderate motor and sensitive axonal polyneuropathy. The normal cerebral CT scan excluded an upper motor neuron disease and the lombar IRM although showed a L1-S1 disc herniation with L3 radicular contact, the symptoms did not respect the radicular distribution and so it was excluded a posterior spinal cord column lesion.
Results: The particularity of this case is illustrated by the etiology of the gait disorder and the false positive Babinski sign that in the end turned out to be dystonic postures in the off periods. Another interesting aspect illustrated by this patient is the relationship between Parkinson disease- vitamin B12 deficiency- polyneuropathy.
Conclusion: All Parkinson patients exposed for a long period of time to high doses of dopaminergic medications that show signs of polyneuropathy should be tested for vitamin B12 deficiency, although it is said that this can be consider non-motor manifestation and sign of disease progression.
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To cite this abstract in AMA style:IE. Petre, M. Marian. Paresthesia and gait impairment in a patient with advanced Parkinson disease-case report [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/paresthesia-and-gait-impairment-in-a-patient-with-advanced-parkinson-disease-case-report/. Accessed December 5, 2023.
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