Clinical history: A 57-year old woman presented with left hand pain, periodic leg movement during sleep, gradual onset of stiffness, clumsiness, and falls. Neurological examination showed: generalized rigidity and bradykinesia. There was left hand dystonic posturing and ideomotor apraxia, as well as mirror movements of upper limbs and stimulus-sensitive myoclonus. The patient had a high-pitched voice and hypophonia (Video S1).
Discussion: Experts discuss localization and the syndromic diagnosis and predict the underlying pathology. The pathological diagnosis is then provided and clinical learning points are considered.
Keywords: alpha‐synuclein; corticobasal syndrome; cytoplasmic inclusions; multisystem atrophy; myoclonus; parkinsonism.
© 2019 International Parkinson and Movement Disorder Society.