History
Mrs. Chan was a 90-year old lady with a history of chronic progressive dementia without movement disorder since her initial presentation 15 years ago.
She was admitted for a right hip fracture.
Her relatives reported a 2-year history of insidious onset, intermittent shaky hands.
She was not on any medications that could account for her symptoms.
Physical examination
Physical examination revealed non-rhythmic, low-amplituide hyperkinetic movements affecting the bilateral fingers and hands. Variable fingers were involved to different degrees throughout the observation.
There were also subtle extrapyramidal signs bilaterally in the upper limbs.
Investigations
A CT of the brain demonstrated global cerebral atrophy. Baseline blood tests were remarkable for a stable normocytic anemia and elevated creatinine. Thyroid function test was normal.
Thought process
The phenomenology can be compatible with an insidious onset polyminimyoclonus in a syndrome of chronic progressive dementia.
The pathology was likely localized to the cerebral level.
In the clinical context of an advanced dementia, the etiology was likely to be neurodegenerative.
Next steps
Clinical monitoring was suggested as the symptoms did not interfere significantly with activities of daily living.