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Parkinson's Disease

Stiff 2

Step 1: View clinicals

A 57 year old woman presents with a 3 year history of worsening difficulty with fine movements of her right hand and stiffness in her right shoulder. During this time period, she developed a rest tremor in her right hand, which spread to involve her right arm and leg and is now present on movement as well. Over time she has become slow in her work and finds it difficult to maintain balance and turn in bed. She finds her daily activities to be a burden and has retired early. Her medical history is unremarkable and she is not on any drugs.

Step 2: Order all relevant investigations

Mini Mental State Examination

The MMSE score is 25 points (normal: >24)

MRI brain

The MRI of the brain appears normal.

Levodopa Challenge

There is clinically significant improvement in the Unified Parkinson Disease Rating Scale (UPDRS) one hour after administration of oral carbidopa/levodopa.


The EEG appears to be normal.

Step 3: Select appropriate management

Levodopa + Carbidopa
Dopamine Agonists
High-fibre Diet

Score: ★★☆