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Washington University Experience | NEURODEGENERATION | NBIA1 (PKAN, Hallervorden-Spatz Dz) | 5A0 Case 5 History
Case 5 History ---- The patient was a 90 year old man with parkinsonism who was admitted for dehydration, one of several admissions for dehydration, hyponatremia, and malnutrition. At baseline he was disoriented with hallucinations. The day prior to admission, he was started on Effexor (Venlafaxine) by his medical doctor for depression. On the day of admission, the patient was noted to have right upper extremity choreoathetoid movements as well as cramps in both of his lower extremities and was also severely dehydrated (BP 92/50) with a sodium of 133. He had a resting tremor in both hands and increased tone with cog-wheel rigidity. He was treated with antibiotics and IV fluid hydration. With this treatment his mental status and general appearance improved, however, he continued to have dyskinetic movements of his right side. Movement disorder specialists felt that the dyskinetic movements were most specifically right-sided hemiballismus. It was felt that this was most likely secondary to left striatal/subthalamic stroke. Head CT was unremarkable. He was treated with Clonazepam and Valproic acid which seemed to help the hemiballistic movements; however, he became more sedated. He had low O2 saturations and a chest x-ray revealed right lung pneumonia. His respiratory status never improved and he subsequently became septic and died.
