Case 18 Neurology

Old man with a masked face

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

This patient presents for evaluation after family noticed he’s been “slowing down” recently. We walk in to meet him. How old do you think he is? Perhaps there is already a clue to the underlying diagnosis.

Clue 2

After speaking with him, our clues are starting to add up.

Clue 3

We take a look at his hands to further test our hypothesis. (The hands are often a rich source of diagnostic information.)

Clue 4

A classic finding is present. We move on to evaluate his gait, anticipating what we might see. And we see it

Clue 5

A classic freezing and festinating gait is observed. As the French say, marche à petits pas (“walking in little steps”). The patient has difficulty getting started, as if the feet are glued to the floor. We diagnosed Parkinson’s disease with our eyes only.

By the way, this patient is older than 70 years. The expressionless “masked facies” of Parkinson’s can possibly make patients appear younger than they are.

End of case.