Clinical Manifestations

A patient presented to movement disorder clinic with cognitive complaints, imbalance and prior diagnosis of NPH. The patient underwent ventriculoperitoneal shunt in the past with minimal improvement, a detailed history is suggestive of REM sleep behavioral disorder, autonomic dysfunction including orthostatic hypotension and urinary incontinence. Clinical evaluation was notable for bradykinesia, rigidity, truncal and cervical dystonia, shuffling steps, reduced arm swing bilaterally and pink, dusky skin of both hands. DaTscan showed reduced uptake of dopamine transporter. Evaluation at movement disorder clinic helps early diagnosis of neurodegenerative disorders with subtle findings which allows patients to benefit from available treatments and participation in appropriate clinical trials.