ABSTRACT
CASE PRESENTATION In mid-1999, a 53-year-old woman noticed stiffness and slowness of the right lower limb associated with falls to the front. There was only mild improvement on L-Dopa. Addition of entacapone resulted in no further benefit. There was a pronounced postprandial tiredness at this time. Urinary incontinence developed, and she became constipated, requiring the frequent use of laxatives. When we first saw her at the end of 2002, we observed broken-up smooth pursuit eye movements, gaze-evoked nystagmus at an eye position of more than 45°, slowing of vertical saccadic eye movements, neck and limb rigidity, bradykinesia, and limb ataxia. She pushed herself up with the arms when attempting to arise from a chair. There was postural instability, wide-based stance, mild start hesitation, freezing when turning, and dragging of the right lower limb. At that time, the patient also complained of dysphagia with occasional choking, and features suggestive of a rapid eye movement (REM) sleep behavior disorder (RBD).
