Table of Contents
Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 6 LBD - Microscopic Pathology - Cerebral Cortex | 11A0 Case 11 History
Case 11 History ---- This 83yo male was first seen in the Movement Disorders Center in 2006 at age 77 years as the result of a resting tremor of the hands. Within a few months, buttoning his shirts became slower and left handed handwriting became less legible. His voice became softer. He had choking when swallowing at that point with some excessive salivation. Over the next two years, walking became slower; he had more trouble arising from deep chairs and he developed mildly diminished mood. Levodopa provided good motor response. In the next year, he developed mild constipation. About one year ago, he developed freezing with start hesitation that responded to levodopa. He developed mild wearing off. Memory and concentration started to wane slightly with modest trouble with financial transactions. He had no dyskinesias and only rare night time dystonia in the legs. In the last year, he developed choking on solids more than liquids. He also developed mild urinary urgency with occasional leaking. Constipation increased. His wife started to remind him of the day of the week. In the last few months, he had trouble with activities of daily living due to cognitive impairment. He did not have excessive daytime sleepiness and only rare nighttime visual hallucinations and a sense of someone else around him. The week before he died, he developed pneumonia, was hospitalized, intubated and treated with haloperidol for agitation for several days. He became stiffer and developed more respiratory problems likely related to pulmonary fibrosis. He was placed on hospice care; given morphine and weaned from supplemental oxygen. He died with respiration insufficiency due to pneumonia.
