Keith is a 35-year-old male Caucasian. While he had had a seemingly normal childhood and graduated high school with a 3.9 GPA, things began to slide downhill after that. His grades began slipping in college and he barely graduated with a 2.0 GPA. It was at that time that he began to experience strange finger twitchings, facial contortions, and random jerks of his arms. His doctors tried various treatments. Surprisingly enough, antipsychotics seemed to help with the odd movements for a while.
After graduation, Keith’s personality changed completely. He became nearly a hermit, had significant difficulty making eye contact, and barely answered when spoken to. He started working at McDonald’s at the age of 24. During that year his coworkers noticed that he became steadily more and more uncoordinated. He began dropping things with regularity, and seemed to have difficulty walking smoothly. He eventually was fired from his job, apparently for failing to appear at work as needed and being totally ineffective when he did appear.
By the age of 28, he was in a doctor’s steady care, exhibiting a host of symptoms including dysarthia, stiffness, and ataxic gait. By the age of 30 he had developed dementia of a type typically expected in much older men. Regrettably, this required that he be placed in a nursing home.
A wide battery of tests yielded the following results:
- No indications of cancer, tumor, or other such conditions.
- He scored quote low on a mini-mental status exam.
- He continued to show dysarthria, combined with an increased muscle tone in all extremities and a wide-based ataxic gait.
- A DNA test yielded a positive result for an inheritable disease, although his one sister was found to be negative on the same test.
- Antipsychotics seem to control some of his dementia symptoms while botulinum toxin helps with some of Keith’s dystonia.
Questions
- What condition or conditions (there may be more than one possibility) are being described in this case? Does this involve brain damage, a specific disease or disorder, or some other condition that may be affecting the patient’s ability to move?
- What brain area or area(s) may be involved? How should they function normally? What could be causing this dysfunction?
- How would the treatments recommended affect the brain? How might those effects relate to the symptoms?
- How can you explain all of the symptoms exhibited by this case? Can you relate each symptom to a specific brain area or neurotransmitter?
- What other interventions may be possible, besides those noted here?
Remember to document your sources!
Originally published at http://www.sciencecases.org/mini_movement/5keith.asp
Copyright © 1999–2010 by the National Center for Case Study Teaching in Science. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.
