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Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 6 LBD - Microscopic Pathology - Cerebral Cortex | 6A0 Case 6 History
Case 6 History ---- This 79yo female had a long history of parkinsonism that began at age 61 years with some difficulty with timing strokes in tennis, then forward flexion of the neck and within one year, she developed right hand resting tremor. Handwriting became smaller, right arm swing decreased, cramping of the right foot developed and then she had increased stiffness, more on the right. Over the years, she had involvement of both sides of the body, gait slowness, and freezing but excellent response to levodopa. She eventually developed wearing off, peak dose dyskinesias and was prone to marked orthostasis. At age 70, she had implantation of deep brain stimulators targeting both subthalamic nuclei (STNs) with excellent response. Levodopa dose was lowered and orthostasis diminished. About 5 to 7 years prior to death, she developed progressive word finding difficulty, increasing trouble with short term memory and disorientation. Her Mini-Mental State Examination (MMSE) dropped to 25/30 in August 2004 and continued to decline to 17 when last measured. Dementia progressed but she was able to recognize her physician. She had had trouble with dystonia during her parkinsonian course and she received botulinum toxin for painful retrocollis. Initial clinical impression was idiopathic PD and final clinical diagnoses included idiopathic PD and co-existing dementia – probably due to cortical Lewy pathology.
