Thursday, October 23, 2014
A 60 year old man with depression is brought in by his wife for strange behaviors while he's asleep. His wife says that over the last few years, she's noticed repeated episodes of vocalization and movement while he's asleep. The movements last less than a minute long but are purposeful; she says she's seen him throw a ball. He often makes benign hand gestures, and occasionally punches or kicks. He sometimes shouts or yells. Most times, he doesn't awaken, but occasionally he wakes up momentarily before falling back asleep. He usually remembers his dreams, and when he awakes, he might be briefly confused, but orients quickly. All these episodes happen during the EEG shown above. For social history, he did not graduate high school, he currently smokes a pack a day, and he has some pesticide exposure from farming. Review of systems is remarkable for anosmia and constipation.
Challenge: In a decade, he is diagnosed with Parkinson's disease, but what does he have now?
Image is in the public domain.