The Patient with Parkinson’s Disease
A 62-year-old man with a 6-year history of Parkinson’s disease, treated with Sinemet 25/250 mg b.i.d. and Amantadine 100 mg. b.i.d., was brought to the ER by Emergency Services personnel. The patient’s family had become alarmed when he did not answer the telephone that morning. They came to his home and found him on the floor, confused and unable to rise. It was estimated that the patient had been disabled for a period of 18–24 hours. On physical exam, the patient was a thin cachetic man, somewhat disoriented, displaying diffuse tremor, pinrolling movements, and stiff facial expresion. Blood pressure, supine, was recorded at 140/80, heart rate 90/min. Upon sitting, blood pressure was 90/60 and heart rate 116/min. The patient was also noted to have a marked deformity of the right hip which was extremely painful on attempted rotation. X-ray of the right hip revealed a fracture of the femur.
Laboratory data was remarkable for a hematocrit of 47%, and BUN/ creat. of 41/1.3. Chest x-ray within normal limits.
He was scheduled for open reduction and internal fixation of the right hip as soon as possible.
KeywordsCaudate Nucleus Parkinsonian Patient Drug Holiday Anesthetic Consideration Olivopontocerebellar Atrophy
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