Parkinson’s Disease

A 70-year-old ex-army officer, presented with progressive slowness of movement and resting tremor of hands (right > left) for 12 years. He was being treated with medicines along with physiotherapy and had been doing well until 3 years earlier. Then, he developed additional progressive difficulty in walking characterized by sudden stopping while walking and tendency to fall while turning around. There were abnormal movements in the form of slow jerky and tonic posturing of upper limbs, neck and trunk which were prominent during the period of off-medicines. These symptoms had significantly increased in last 2–3 months. He gave history of erectile dysfunction. There was no abnormal movement of jaw or tongue, fall, imbalance, dizziness, diplopia on upgaze, or impaired smell and taste sensations. He had no recent stress, fever, cough, burning micturition, or other systemic diseases like hypertension, diabetes mellitus, or pulmonary tuberculosis. He was non-vegetarian, an ex-smoker, and had given up alcohol consumption 3 years before.