History

Chief Complaint:

“My husband is slowing down and his hands won’t stop shaking. “

History of Present Illness:

Mr. R.D. is a 73 year old white male who was referred to the Neurology clinic by his PCP. Prior to retiring in 2009, Mr. R.D. was a math professor.  In his free time, he enjoyed playing the piano and cooking. After retirement, he and his wife were active in senior groups and also volunteered at the local high school tutoring students in math. Over the past 9-12 months, his wife noticed that he was less interested in attending senior functions and was less active in general. She thought he was just tired and encouraged him to take naps, which initially helped. Over the last 6 months, he continued to be fatigued (with little activity) and had stopped cooking. Mr. R.D. has also stopped enjoying his food. Recently, he has begun complaining that food does not taste as good as in the past.  His wife commented that she thought they were just “getting older”, however when she realized it was taking much longer to solve math problems—something he previously completed very quickly—she “knew something was wrong”. Upon questioning, Mrs. R.D. indicated that he had occasional urinary hesitancy and constipation. She also stated that his hands are “shaking constantly”.

Past Medical History:

  • Tonsillectomy/adenoidectomy at age 5
  • R ulnar fx. And R femur fx. From MVA at age 18
  • Hyperlipidemia
  • Hypertension
  • Diabetes Type II (controlled with diet and exercise)

Pertinent Family history:

  • Both parents deceased
    • Mother passed away from MI
  •     Father was killed in an MVA
  • Both parents had hypertension

Pertinent Social History:

  • Math professor for 30 years
  • Avid reader
  • Piano player
  • Enjoyed cooking
  • Previously very active in his senior group
  • Enjoyed an active lifestyle of walking, bike riding, and swimming

Allergies:

  • No known drug allergies

Medications:

  • Lipitor 10mg daily
  • Lisinopril 20 mg daily
  • Atenolol 50mg daily

Focused physical exam:

Neuro:

  • A&Ox4, cooperative
  • Flat affect, minimal facial expressions
  • Hands resting on thighs, tremors noted bilaterally
  • Reflexes delayed when checked in knees
  • When standing, patient noted to be bent forward, arms stiffly at sides, jerking movements
  • When asked to walk to the door, noted to take short, shuffling steps, leading with his head
  • His wife stood at the door and stopped him