73-Year-Old Man With Gait Disturbance and Imbalance

Abstract

A 73-year·old right-handed man with a history of diabetes, hyperlipidem ia, co ronary artery disease, and asthmatic obstructive lung disease came to our institution beca use of a 2year history of gradual worseoiog of gait aod balaoce. One year previously, he had undergone coronary artery bypass grafting without perioperative complica tions. Subsequently, h is gait worsened, and his fee l felt "glued to the floor." During the 2 years before the curre nt examination, he also noticed urinary urgency, occasional incont inence, and irnpotcnce. His wife noti ced that he had had some mental slo wing and forgetfulness during the precediog 18 months. Review of systems revealed no history of tremo r. speech change, diffi culty with use of his arms, or wea kness . Five months before the current assessment, a neu rol ogist had noted parkin son ism; amantadi oe hydrochlori de and carbidopaIcvodopa were prescribed separate ly but yielded no benefi t. On initi al consultation , the patient had norm al mental status and cranial nerve func tions. Motor examina tion showed generally preserved strength, red uced aokle jerks, and flexor plantar responses bilaterally. Muscle tone was mildly spastic in the legs. Sensory examinat ion showed mild hypoe sthesia 10 pinprick in bot h hands (fingertips) and feet (up 10 the ankles); other sensory modalit ies were normal. His ga it was wide-based , and externa l anal sphincte r tone was mildly reduced . Parkinsoni an signs included shuffl ing gait, slowed walking, and postural instability.