8. This 70-year-old right-handed white male retired salesman was referred for neurological consultation. Symptoms included a generalized slowing of many motor activities. Especially prominent in this was a tendency to walk with a stooped posture and with diminished arm swing. However, almost all motor activities were performed more slowly and deliberately than before. A mild tremor or "nervousness" of the right upper limb was noted. This patient's signs and symptoms constitute a classical neurologic syndrome (has to do with the basal ganglia). What is the name of that syndrome? What is the anatomical location of the basic pathologic process leading to this patient's condition? What anatomical pathway(s) is involved in this patient's condition? What neurotransmitter systems are involved in the manifestations of this syndrome, and which manifestations are associated with which neurotransmitters?
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Step 1: The classical neurologic syndrome described in the patient is Parkinson's disease, which is associated with dysfunction of the basal ganglia. Show more…
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A 54-year-old right-handed female consulted a neurologist for complaints of numbness in her feet for the past two weeks with "pockets" of numbness in the abdomen. Her legs feel heavy and numb. Her hands started tingling a week ago, and she is feeling very nervous. She has had similar episodes over the past three (3) years, lasting about a week at a time, often after stressful events or during hot weather. She states that at times her vision is blurred. PMH: No operations/no serious illnesses/accidents Father: age 71, L & W; Mother, age 66, is bipolar Her only sibling, a sister, age 28, has cerebral palsy. SH (social history): denies smoking or use of street drugs, drinks socially OH (occupational history): certified public accountant. Marital status: married ROS: non-contributory VS: T 98.2°F, P 82 and regular, R 16, B/P 110/68, Ht 5'3", Wt. 140 lbs. PE: HEENT: WNL. Neck: negative, heart/lungs: normal Cranial nerves intact. Reflexes: DTRs are increased, greater on the right without spasticity. There is numbness to tactile pin stimulation over both extremities. She demonstrates ataxia. Dx: R/O MS (Rule out Multiple Sclerosis) Plan: Schedule MRI of the brain with and without contrast. Describe the test the patient is scheduled to have. It is a scan produced by magnetic fields and radio frequency waves.
Madhur L.
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A 50-year-old chronic smoker comes to your clinic complaining that he has noticed he is having more difficulty rising from a chair, climbing stairs, and walking. He has always been very active and is in good physical health. He first noticed that his legs felt weaker about a year ago. He thought it was just part of normal aging, but he has noticed that his weakness has slowly progress. He states that occasionally his legs ache. You inquire about other autonomic symptoms and he indicates that he also has xerostomia. You suspect that he may have Lambert-Eaton myasthenic syndrome (LEMS). What causes muscle weakness in patients with LEMS? If you could record from presynaptic motor neuron terminals, what changes would you expect to find in terms of presynaptic Ca2+, Na+, and K+ influxes? If you could record from the affected skeletal muscles in the legs, what changes would you expect to find in terms of miniature endplate potentials, endplate potentials, and success rates of action potentials in response to motor nerve stimulation? Use drawings to illustrate your predictions. LEMS can be treated with 3,4-diaminopyridine. Explain how this medication alters skeletal muscle physiology to reduce muscle weakness. Use drawings to illustrate your predictions. Explain why hypermagnesemia and calcium channel blockers can exacerbate muscle weakness in patients with LEMS? Explain what causes xerostomia in this patient. Include the nerves, neurotransmitters, receptors, and tissue involved in your explanation. Since the patient has symptoms of xerostomia, what other symptoms should be looked for in this patient? What other medications could help reduce the patient’s muscle weakness and xerostomia. Explain how these medications work. What other diseases are associated with LEMS?
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