A 36-year-old Nigerian Hausa man who had undergone an appendicectomy was referred to our neurology unit with tremor at r
Posted: Mon Apr 04, 2022 6:39 am
A 36-year-old Nigerian Hausa man who had undergone an
appendicectomy was referred to our neurology unit with tremor at
rest and bradykinesia. The surgery had been uneventful, and our
patient had not taken any medication likely to affect the central
nervous system for six weeks before his surgery. His only
medication had been the halothane that was used as general
anaesthetic for his appendicectomy, along with preoperative
medications consisting of 5 mg diazepam injections, 1 mg starting
dose of atropine, and 50 mg of pethidine. Postoperatively, he
received intravenous ampicillin and cloxacillin at a dose of 1 g
every six hours for one week, and 50 mg of tramadol every 12 hours
for five days. He has no family history of PD.
A careful neurological evaluation revealed asymmetrical
rigidity, affecting the right side more than the left, with
hypokinesia and tremor. Laboratory investigations, including full
blood count, electrolytes and urea, and testing for malaria
parasite, HIV and syphilis were essentially normal.
Our patient was diagnosed with drug-induced parkinsonism (DIP)
and started on levodopa/carbidopa (250 mg) daily. After three days
of treatment, the symptoms resolved completely and six weeks after
he remained healthy.
PLEASE DISCUSS DIAGNOSIS, PROGNOSIS. ASSESSMENT AND THE
MANAGMENT NEEDED. ANY POSSIBLE RECCOMADATIONS ASWELL. THANK YOU
appendicectomy was referred to our neurology unit with tremor at
rest and bradykinesia. The surgery had been uneventful, and our
patient had not taken any medication likely to affect the central
nervous system for six weeks before his surgery. His only
medication had been the halothane that was used as general
anaesthetic for his appendicectomy, along with preoperative
medications consisting of 5 mg diazepam injections, 1 mg starting
dose of atropine, and 50 mg of pethidine. Postoperatively, he
received intravenous ampicillin and cloxacillin at a dose of 1 g
every six hours for one week, and 50 mg of tramadol every 12 hours
for five days. He has no family history of PD.
A careful neurological evaluation revealed asymmetrical
rigidity, affecting the right side more than the left, with
hypokinesia and tremor. Laboratory investigations, including full
blood count, electrolytes and urea, and testing for malaria
parasite, HIV and syphilis were essentially normal.
Our patient was diagnosed with drug-induced parkinsonism (DIP)
and started on levodopa/carbidopa (250 mg) daily. After three days
of treatment, the symptoms resolved completely and six weeks after
he remained healthy.
PLEASE DISCUSS DIAGNOSIS, PROGNOSIS. ASSESSMENT AND THE
MANAGMENT NEEDED. ANY POSSIBLE RECCOMADATIONS ASWELL. THANK YOU