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“A 60 year old man presents to your office with imbalance and a few falls. He has had some severe bumps and bruises from the falls, which prompted him to come in to see the doctor. Symptoms seemed to begin about 6 months previously, and are slowly getting worse. Also noted is a tremor that primarily involves the right hand, and is most prominent when at rest and when walking. In fact, the patient barley notices it but it is very bothersome to his wife. His movements, according to his wife, seem very slow and stiff.
The patient does not make good eye contact when being spoken to, and gaze is directed downwards. Facial expression is limited, and there seems to be a paucity of spontaneous movements. All movements, including walking, speaking, reaching, etc. are very slow but performed accurately. There is a tremor, most prominent in the right hand, which is most noticeable at rest and goes away when reaching for objects. It is also enhanced when walking, and writing is poor. Walking is slow with short, shuffling steps. “
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