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A previously healthy 58-year-old right-handed woman presented with a 2-month history of progressive asymmetrical extrapyramidal symptoms and signs suggestive of idiopathic Parkinson's disease. On examination, she had moderate hypomimic facies with hypophonic speech. She had a reduced right arm swing and a slow gait, although it was neither festinated nor shuffling and had a normal base. A resting pill-rolling tremor of about 3–5 Hz was evident in the distal right upper limb affecting the thumb and wrist, as well as an intermittent low-amplitude and low-frequency tremor of her jaw. There was no associated postural, kinetic or intention component to the tremor. In addition, cogwheel rigidity of the wrist, and bradykinesia of rapid finger movements were observed on the right. The resting tremor and cogwheel rigidity was accentuated …
Contributors MF and WH were involved in the management and care of the patient and preparation and drafting of the manuscript. AG was involved in the management and care of the patient. LM was involved in the management and care of the patient and selection of the figures.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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