Case 46-1993

Presentation of Case A 75-year-old right-handed man was referred to the Movement Disorders Unit of this hospital because of right-sided rigidity, dysphagia, dysarthria, and an impaired gait. The patient's health had been stable until two years earlier, when his family began to observe episodes of “unresponsiveness.” A magnetic resonance imaging (MRI) scan of the brain obtained elsewhere (Figure 1, 2, and 3) showed atrophy and hypointense areas in the basal ganglia on T2-weighted images considered consistent with calcifications or iron deposits. No additional episodes occurred after phenytoin treatment. One year later the patient began to lose his balance . . .