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Washington University Experience | NEURODEGENERATION | Corticobasal Degeneration (CBD) | 5A0 Case 5 History
Case 5 History The patient was an 82yo male who was thought to suffer from Alzheimer's and Parkinson's disease. He was first seen by a neurologist in 1/93 (age 79) complaining of a two year history of language problems which included both comprehension and word finding difficulties. On neurologic exam at that time, the patient had marked short term memory loss. Cranial nerve functions were normal except for tongue protrusion which deviated slightly to the right. Pain, tone, vibration and position senses were normal for age. There was mild spasticity of the right upper limb and fine movements of the right hand were slow and clumsy. There was some spasticity of right knee movement. Symptoms and signs localized a lesion to the left frontal lobe and a degenerative disease such as Alzheimer's was thought likely. An MRI examination of the brain demonstrated a small arachnoid cyst in the medial portion of the left temporal lobe and nonspecific aging changes. Correctable causes of dementia, including B12 and folate deficiency and hypothyroidism were investigated and excluded. The patient suffered a gradual deterioration in memory throughout 1993. In early 1994, when seen again, he had developed a shuffling gait, severe retropulsion and cogwheeling. A diagnosis of Parkinson's disease was made and the patient was started on Sinemet. Later that year, the patient was hospitalized at BJH following a fall. The patient entered a nursing home. When last seen in 2/95, the patient could follow only simple one step instructions and he was unable to move the right side. He could no longer name objects. Glabellar and snout reflexes were present; however, grasp and palmomental reflexes were absent. The patient expired in 5/96.
