Clinical features are completed by: hypomimia
or immobile facial "mask" with rare blinking, without eye or facial movements; hypokinetic or hypophonic dysarthria; dysphagia; small writing (micrographic); reduction of respiratory movement amplitudes; sometimes sharp and medication psychiatric disorders (depression, cognitive disorders, episodes of agitation, sleep disorders, confusion), constipation, sexual deficit, diffuse pains in lower limb, paresthesia, fatigue; (Marcu, 2006)
2) Additional features- hypomimia
(masked face), freezing episodes (sudden onset failure movement), and seborrhea of the scalp, mental or cognitive disturbances.
It can include micrographia, hypomimia
, hypophonia as well as decreased blink rate.
Severe movement abnormalities and psychomotor deficits can sometimes be observed in patients with HAD, most notably in the form of bradykinesia (slowed movement), hypomimia
, action/ postural tremor and hand agility, as well as bradyphrenia (slowed information processing).
Both clinicians describe frontal release signs, anarthria, facial hypomimia
, bilateral mild central paresis, absence of soft palate elevation with symmetrical phonation, decreased gag reflex and palatal atrophy, fasciculations, and bilateral lingual mandibular reflex and diagnose Ms.
Other clinical features include secondary motor symptoms (eg, hypomimia
, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing, dystonia, glabellar reflexes), non-motor symptoms (eg, autonomic dysfunction, cognitive/neurobehavioral abnormalities, sleep disorders and sensory abnormalities such as anosmia, paresthesias and pain).
She had tremor of the hands, rigidity in both arms and hypomimia
, which are the characteristic features of Parkinson's disease (Figure 1).
Mild to moderate dysarthria, hypophonia with a monotone voice, and hypomimia
She exhibited hypomimia
, limb rigidity with intermittent cogwheeling, and left arm dysmetria.