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A Metallic Brain!

Topic: Adult

Created on Thursday, October 23 2008 by rednucleus

Last modified on Thursday, October 23 2008.

A 19-year-old male presents with shaky hands. He has bilateral resting tremor with intentional component as well as dysarthria. His urine is positive for sugar but his random blood sugar never exceeds 100 mg/dl. What is the likely diagnosis this man has?

A) Idiopathic torsion dystonia

B) Juvenile Huntington's disease

C) Juvenile Parkinson's disease

D) Early onset Alzheimer's disease

E) Wilson's disease

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This question was created on October 23, 2008 by rednucleus.
This question was last modified on October 23, 2008.

ANSWERS AND EXPLANATIONS

A) Idiopathic torsion dystonia

This answer is incorrect.

The adult onset type is usually generalized rather than focal but does not have "resting" tremor or renal involvement. (See References)


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B) Juvenile Huntington's disease

This answer is incorrect.

This variant may have Parkinsonism and seizures but there are additional psychiatric manifestations and chorea. No renal affection is present. (See References)


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C) Juvenile Parkinson's disease

This answer is incorrect.

The tremor is usually unilateral and may have postural component (but not intentional one) and it does not affect the renal tubulo-interstitium. (See References)


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D) Early onset Alzheimer's disease

This answer is incorrect.

Even if it has an early onset, Alzheimer's disease is a cortical type of dementia that does not present with bilateral resting tremor. (See References)


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E) Wilson's disease

This answer is correct.

Note the combination of "resting" and "intention" tremors in this young man with dysarthria and proximal renal tubular acidosis (glycosuria with normal blood sugar). (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
A Metallic Brain!
Question ID: 102308127
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/23/2008
Modified: 10/23/2008
Estimated Permutations: 120