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A 54 yr old computor analyst form arizona presented with difficulty in walking. He is having problems in initiating the walk but problems are less after 5 mins of walking. He has no pain in legs and there is no numbness. On examination legs showing increased tone with normal power , babiniski is normal. on examination of hands there is a mild oscillating movement of 6 hz when he showed the hands. This movement dissapeared when he was asked to write his name on paper. Vitals BP on standing 110/54 supine 140/74 pulses 78/min. He is a chronic alcoholic & this hand movement is not benefited by taking alcohol. Which of the following pharmacological measures will be most beneficial for this patient?
a. Levo/carbidopa
b. Benztropine
c. selegiline
d. amantadine
e. fludrocortisone
f. restrict protein meal at night
Please explain ur ans this is commonly asked.
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if no1 wants to attempt i will give the ans
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Resting tremor,bradykinesia in intiating the walk...not benig essential tremor ,not intention tremor..Rx Levo-carbidopa....
J
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its not that easy as it appears
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he has problems initiating movements.... so Basal ganglia problems... and also He has resting tremors suppressed on activity again suggests onset of parkinsosn... For tremors ... if we give Benztropine... It will improve... so as other symptoms not there .. Only Benztropine? BBBB....
essential tremors ruled out as alcohol doesnt releive it?
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essential tremors can b prevented by alcohol....
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Fludrocortison. The guy has Orthostatic Hypertension.
The tremor is resting tremor as it is 6 Hz... no treatment for that.
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Parkinsonism with orthostatic hypotension diagnosis is SHY DRAGOR SYNDROME
Treatment:
1. Fludrocortisone
2. Salt supplement
3. alpha agonist
4. constrictive garments
This patient will have severe problems like syncope ...so treatment for hypotension is essential...IV fluids even wont help this patient much.
