Case Challenge: A Veteran With Tremor and Impaired Walking
Case Challenge: A Veteran With Tremor and Impaired Walking
A 45-year-old right-handed Air Force veteran came to clinical attention with a complaint of increasing tremor and difficulty walking. He complained that he had previously been quite athletic and well coordinated, but he had begun shuffling "like an old man." There was no family history of similar problems.
On exam he had stable vital signs; he was alert and well oriented without obvious cognitive deficits. Physical exam disclosed normal cardiac, pulmonary, and abdominal examinations. Neurologic exam was notable for bilateral resting arm and hand tremor -- which was greater on the right -- and increased tone in the upper and lower limbs. There was no atrophy, myotonia, or weakness. His gait exhibited festination, and the remainder of the neurologic exam was unremarkable.
Case Presentation
A 45-year-old right-handed Air Force veteran came to clinical attention with a complaint of increasing tremor and difficulty walking. He complained that he had previously been quite athletic and well coordinated, but he had begun shuffling "like an old man." There was no family history of similar problems.
Physical Exam
On exam he had stable vital signs; he was alert and well oriented without obvious cognitive deficits. Physical exam disclosed normal cardiac, pulmonary, and abdominal examinations. Neurologic exam was notable for bilateral resting arm and hand tremor -- which was greater on the right -- and increased tone in the upper and lower limbs. There was no atrophy, myotonia, or weakness. His gait exhibited festination, and the remainder of the neurologic exam was unremarkable.
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