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pt 54y/M

No headache/diplopia/vertigo/blurring of vision No major head injury No bladder & bowl complain Chief Complaints C/o Lt knee pain since 2 years,increase complain since 8 months -difficulty in walking and sit to stand-(recurrent fall) -slurring speach since 8months -complain gradually slowness in all activities -imbalance while walking-recurrent fall -difficulty in understanding & finding words -confused and delay response -disorieantation about time &place -memory impairment -forget about he had eaten or not -irrelavent talk occ -laughing without any reason -irritability & easily angry -dislike to talk -starred look No headache/diplopia/vertigo/blurring of vision No major head injury No bladder & bowl complain History #Personal history:; Appetite- normal Sleep-disturbed Addiction-alcohol stop since 3 yeas #past history:; No DM/HTN F/h/o:; Father had asthma Vitals Tem-normal HR-85 Bp-127/85 Investigations MR brain - mild cerebral & cerebellar atrophy with small vessels ischemic changes Diagnosis ? progressive supranuclear palsy kindly give some opinion please

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Looks like progressive supranuclear palsy Loss of vertical gaze; that is inability to look upwards; is very simple important test to distinguish it from Parkinson's disease Usually it has rapid progression causing debilitation and immobilisation

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Looks like progressive supranuclear palsy Loss of vertical gaze; that is inability to look upwards; is very simple important test to distinguish it from Parkinson's disease Usually it has rapid progression causing debilitation and immobilisation

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Available information is not going well with PSP.On exam no mention about the eye movements and axial rigidity.He has cerebellar symptoms with higher function changes especially frontal lobe involvements . This patient needs a good neurological exam findings which is lacking in the presentation. MRI shows cortical atrophy with cerebellar atrophy with CSVD.Better to post the MRI films. Progressive degenerative disorder is possible. At the age of 54 ,he has features of CSVD which needs further work up also. Better to see a Neurologist for good physical exam.

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Progressive supranuclear palsy (PSP) is a late-onset degenerative disease involving the gradual deterioration and death of specific volumes of the brain. The condition leads to symptoms including loss of balance, slowing of movement, difficulty moving the eyes, and cognitive impairment... There is currently no effective treatment for PSP.  menu  search COVID-19 Get the latest funding, research, and public health information from NINDS Get the latest research information from NIH | Español Get the latest public health information from HHS Get the latest public health information from CDC Progressive Supranuclear Palsy Fact Sheet What is progressive supranuclear palsy? What are the symptoms?  How is PSP different from Parkinson's disease?  What causes PSP? How is PSP diagnosed? Is there any treatment?  What is the prognosis?  What research is being done? Where can I get more information? What is progressive supranuclear palsy? Progressive supranuclear palsy (PSP) is a rare brain disorder that causes problems with movement, walking and balance, and eye movement. It results from damage to nerve cells in the brain that control thinking and body movement. The disorder’s long name indicates that the disease worsens (progressive) and causes weakness (palsy) by damaging certain parts of the brain above nerve cell clusters called nuclei (supranuclear) that control eye movements. PSP is different than Parkinson’s disease—another movement disorder—although they share some symptoms (see section, “How is PSP different from Parkinson’s Disease?”). Currently there is no effective treatment for PSP, but some symptoms can be managed with medication or other interventions. top What are the symptoms? PSP affects movement, control of walking (gait) and balance, speech, swallowing, eye movements and vision, mood and behavior, and thinking. The pattern of signs and symptoms can be quite different from person to person. The most frequent first symptom of PSP is a loss of balance while walking. Individuals may have abrupt and unexplained falls without loss of consciousness, a stiff and awkward gait, or slow movement. As the disease progresses, most people will begin to develop a blurring of vision and problems controlling eye movement. These symptoms may include: Slow eye movements.Trouble voluntarily shifting gaze vertically (i.e., downward and/or upward).Trouble controlling eyelids.Tendency to move the head to look in different directions.Involuntary closing of the eyes.Prolonged or infrequent blinking.Difficulty in opening the eyes.Inability to maintain eye contact during a conversation. People with PSP often show alterations of mood and behavior. These symptoms may include: Depression.Apathy.Changes in judgment, insight, and problem solving.Difficulty finding words.Loss of interest in ordinary pleasurable activities.Increased irritability and forgetfulness.Sudden laughing or crying or displaying angry outbursts for no apparent reason.Personality changes. Other symptoms may include: Slowness of thought.Memory problems.Slowed, slurred, or monotone speech.Difficulty swallowing solid foods or liquids.Mask-like facial expressions. top How is PSP different from Parkinson's disease? PSP is often misdiagnosed as Parkinson’s disease, especially early in the disorder, as they share many symptoms, including stiffness, movement difficulties, clumsiness, bradykinesia (slow movement), and rigidity of muscles. The onset of both diseases is in late middle age. However, PSP progresses more rapidly than Parkinson’s disease. People with PSP usually stand exceptionally straight or occasionally tilt their heads backward (and tend to fall backward). This is termed “axial rigidity.” Those with Parkinson's disease usually bend forward.Problems with speech and swallowing are much more common and severe in PSP than in Parkinson's disease and tend to show up earlier in the disease.Eye movements are abnormal in PSP but close to normal in Parkinson's disease.Tremor is rare in PSP but very common in individuals with Parkinson’s disease. Although individuals with Parkinson's disease markedly benefit from the drug levodopa, people with PSP respond minimally and only briefly to this drug. People with PSP show accumulation of the protein tau in affected brain cells, whereas people with Parkinson’s disease show accumulation of a different protein called alpha-synuclein. top What causes PSP? The exact cause of PSP is unknown, but research suggests that it involves a gradual deterioration of brain cells in a few specific areas in the brain, mainly in brain stem. The death of brain cells in one of these areas, the substantia nigra, accounts in part for the motor symptoms that PSP and Parkinson's have in common. The hallmark of PSP is the accumulation of abnormal deposits of the protein tau in nerve cells in the brain. These deposits cause the cells to malfunction and die, which stops the flow of information to other nerve cells. The accumulation of tau puts PSP in the group of disorders called the tauopathies, which includes Alzheimer’s disease, corticobasal degeneration, and some forms of frontotemporal degeneration. PSP is usually sporadic, meaning that it occurs infrequently and without a known cause. In very few cases, the disease results from mutations in the MAPT gene. This mutation provides faulty instructions for making tau to the nerve cell. Genetic factors have not been implicated in most individuals. Several theories suggest that PSP might be caused by: The abnormal buildup of the protein tau in a cell causes the building up a connected cell, which then spreads through the nervous system.An unconventional infectious agent that takes years or decades to start producing visible effects (as is seen in disorders like Creutzfeldt-Jakob Disease).Random genetic mutations—the kind that occur in individuals all the time—happen to occur in particular cells or certain genes, in a specific combination that injures these cells.Exposure to some unknown chemical in food, air, or water, which slowly damages certain vulnerable areas of the brain, mimicking a neurological disorder found on the Pacific island of Guam and on a few neighboring islands.Cellular damage caused by free radicals, which are reactive molecules produced continuously by all cells during normal metabolism. Although the body has built-in mechanisms for clearing free radicals from the system, scientists suspect that—under certain circumstances—free radicals can react with and damage other molecules. top How is PSP diagnosed? Currently there are no tests or brain imaging techniques to definitively diagnose PSP. An initial diagnosis is based on the person’s medical history and a physical and neurological exam. Identifying early gait problems, problems moving the eyes, speech and swallowing abnormalities, as well as ruling out other similar disorders is important. Diagnostic imaging may show shrinkage at the top of the brain stem and look at brain activity in known areas of degeneration. top Is there any treatment? There is currently no effective treatment for PSP and symptoms usually do not respond to medications. Parkinson’s disease medications, such as ropinirole, rarely provide additional benefit. In some individuals, other antiparkinsonian medications, such as levodopa, can treat the slowness, stiffness, and balance problems..

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? GERIATRIC CASE WITH .. DEGENERATIVE CEREBRAL CHANGES.. WITH .. ASSOCIATED COMPLICATIONS.. NEED'S.. NEUROLOGICAL EVALUATION .. WITH .. EXPERTS OPINION ..

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Cerebral & cerebellar atrophy Leading to Dementia Ref to Neurologists

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Alzheimer's disease with Osteoarthritis

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Dx unmad. Memory impairment, irrelevant talk, laughing without any reason etc . More questionnaire needs to make out doshic predominance. Vataj,pittaja,kaphaj. Seems to be a case of vata dominant,kapha then pitta. Pcc.

Budhhi vibhram lakshana noted as per complaints.
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I think it's case of alzimer disease...treat with thr help of psychologists

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Cerebral Ataxia OR Cerebral palsy either can be the diagnosis As the condition is progressive as per the symptoms Kindly refer to neurologist

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Advice Vitamin D3 and vitamin B12.Thyroid profile...

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