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60 years/Male, right hand dominant ,retired clear comes with the complains of – difficulty in walking in a narrow space or when surrounded by people, fear of fall, hallucinations n nightmares, slowness of movements and involuntary movements.
HOPI: Pt was AAR 8yrs back when relatives observed tremors in left hand while talking which progressed to tremors at rest and also in lower limb 6 months back. In the past 4yrs, pt is detoriating with slowness in actives of daily living, imbalance in walking and hallucinations.
Personal history : Diet- Normal Sleep- Disturbed (nightmares and daytime sleppiness) Bowel and bladder- Frequent constipation
On examination: Built- Normal Vitals: Bp: 122/84 mm of Hg Pulse: 88 beats /min Respiratory rate: 24 breaths/min Orientation: fluctuating depending on task and posture. Speech: hypophobic and monotonous with reduced blinking and facial expressions
Rigidity in both upper and lower llimbs
Muscle power- 3 to3+ in bilateral upper and lower limbs
Reduced gait velocity with frequent freezing
MRI: Thinning of pars comparta on sides, which is more pronounced on lateral aspect.