[...]... Mini-Mental State: a practical method for grading the state of patients for the clinician J Psychiatr Res 19 75 ;12 :18 9 19 8 This page intentionally left blank This page intentionally left blank 18 CASE FILES: NEUROLOGY ANSWERS TO CASE 1: Essential Tremor Summary: A 65-year-old right-handed gentleman has a 20-year-history of tremor predominantly limited to activities, such as writing, drawing, or holding objects... 2005;4 :10 0 11 0 Lyons K, Pahwa R, Comella C, et al Benefits and risks of pharmacological treatments for essential tremor Drug Saf 2003;26:4 61 4 81 Pahwa R, Lyons KE, Wilkinson SB, et al Comparison of thalamotomy to deep brain stimulation of the thalamus in essential tremor Mov Disord 20 01; 16 :14 0 14 3 Zesiewicz TA, Elble R, Louis ED, et al and the Quality Standards Subcommittee of the American Academy of Neurology. .. family members also are noted to have tremors If ET is diagnosed, what pattern of inheritance is most likely? A B C D E Autosomal dominant Autosomal recessive X-linked dominant X-linked recessive Y-linked 22 CASE FILES: NEUROLOGY [1. 3] A 58-year-old man is noted to have a noticeable tremor that has progressed over 5 years The tremor occurs in the hands, there are some problems with his gait, and there... has severe tremors and if medications are not effective Comprehension Questions [1. 1] A 59-year-old man is diagnosed with a probable ET A PET scan is performed on the brain Which of the following is most likely to be highlighted on the imaging? A B C D [1. 2] Cerebellum Cerebral cortex Pituitary gland Thalamus A 45-year-old woman is noted to have a distinct tremor with voluntary activity Multiple family... require 21 CLINICAL CASES fine-motor skills, or do the things they enjoy Severe tremors can lead to social withdrawal and isolation Fortunately, a variety of treatments exist that may help bring the tremors under control Medications provide relief from tremors roughly half the time The mainstay of ET treatment are beta-blockers and primidone Beta-blockers Normally used to treat high blood pressure, beta-blockers,... weakness, mental status, and speech 12 CASE FILES: NEUROLOGY CLINICAL PEARL ❖ Usually, the vague query, “What is your next step?” is the most difficult question because the answer can be diagnostic, staging, or therapeutic What Is Likely Neuroanatomical Defect? Because the field of neurology seeks to correlate the neuroanatomy with the defect in function, the student of neurology should constantly be learning... straightforward answer is given to each open-ended question 3 The Analysis of the Case, which is comprised of two parts: a Objectives of the Case a listing of the two or three main principles that are crucial for a practitioner to manage the patient Again, the student is challenged to make educated “guesses” about the objectives of the case on initial review of the case scenario, which help to sharpen his... does not cause other health problems, whereas PD is associated with a stooped posture, slow movement, a shuffling gait, speech problems other than tremor, and sometimes memory loss (Table 1 1) 19 CLINICAL CASES Table 1 1 ESSENTIAL TREMOR VERSUS PARKINSON DISEASE ESSENTIAL TREMOR (ET) PARKINSON DISEASE (PD) Onset of disease Bilateral arm involvement Unilateral tremor, associated with stooped posture, shuffling... clonus A urine drug screen is negative ◆ What is the most likely diagnosis? ◆ What is the next diagnostic step? ◆ Molecular or genetic basis of this disorder? 24 CASE FILES: NEUROLOGY ANSWERS TO CASE 2: Huntington Disease Summary: A 40-year-old man is seen in the emergency room for inappropriate behavior and confusion He has appeared “fidgety” for several years and, more recently, has choreiform movements... sometimes it appears during adolescence More often, though, tremors begin in mid to late life The most common sign is a trembling, up-and-down movement of the hands, although the arms, legs, head, and even the tongue and voice box (larynx) can also be affected Most 20 CASE FILES: NEUROLOGY affected individuals have tremors in both hands, and although some have tremors in only one hand initially, there is . Clinical Problems 1 Part 1. Approach to the Patient 3 Part 2. Approach to Clinical Problem-Solving 8 Part 3. Approach to Reading 10 SECTION II Clinical Cases 15 Fifty-three Case Scenarios 17 SECTION. prior written permission of the publisher. 0-0 7 -1 5943 8-8 The material in this eBook also appears in the print version of this title: 0-0 7 -1 4828 7-3 . All trademarks are trademarks of their respective.