Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive gait instability, frequent unexplained falls (often backward), and significant postural instability. Reports symptoms of bradykinesia, axial rigidity, and early-onset dysphagia. Cognitive changes noted, including executive dysfunction and apathy. Symptoms are refractory to standard levodopa therapy.
Clinical Examination Findings
Patient appears frail with a characteristic "surprised" facial expression (frontalis overactivity) and widened palpebral fissures. Significant neck dystonia (retrocollis) noted. Vital signs stable, though orthostatic hypotension may be present. Nutritional status assessed for signs of dysphagia-related weight loss.
Treatment Protocol
Management focuses on symptomatic relief and multidisciplinary support. Trial of Levodopa/Carbidopa initiated (though response is typically limited). Physical therapy for gait training and fall prevention. Speech and swallow therapy for dysphagia. Occupational therapy for home safety modifications. Regular monitoring for aspiration pneumonia.