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Washington University Experience | NEURODEGENERATION | Huntington Disease | 7A0 Case 7 History
Case 7 History ---- This 57yo male had not been seen at Barnes since 1973 when a diagnosis of probable Huntington's chorea was made. At age 29 he had a severe depressive episode that lasted one to two years and gradually improved. At the age of 43 symptoms were first noted of restlessness, irritability, increased alcohol consumption, and paranoid ideation. In 1970 he was admitted for the first tie to Renard for evaluation of paranoid ideation and irritable behavior. At that time he exhibited frequent involuntary quick, jerky movements. An LP and EEG were normal. He was treated with Elavil and thought to have possible Huntington's disease. His work performance deteriorated and he stopped work in 1972. In 1973 he was readmitted to Barnes at which time he was found to have poor recall, judgment, and insight, He now had frequent spontaneous large-amplitude proximal and distal jerking movements. A pneumoencephalogram showed atrophy of the caudate. By 1974 he was in a nursing home where he was noted to be baseline confused with moderate movements. He was still walking and talking, smoking, and feeding himself, but required assistance dressing. He was usually in a happy mood but was distractable and frustrated by his movement disorder. He had periodic deteriorations with increase in his movement and decrease in his mental stats and was tried on INH and Mellaril. By 1974 he was unable to talk, required assistance in feeding, and had moderate to severe movements. In 1978 his frequent falling resulted in his being confined to a chair and he thereafter had little communicative ability. Urinary incontinence resulted in a chronic Foley catheter. One year prior to his death his movements became much worse, such that he would fall out of his chair despite restraints. To avoid harming himself, he was kept on the floor on a mattress. He continued to deteriorate, he was confined to bed for the last month. During this last month it is interesting that he resumed making one word utterances
