Depression, extrapyramidal symptoms, dementia and an unexpected outcome: a case report

INTRODUCTION: The diagnosis of Parkinson's disease is mainly clinical. DaT SCAN may help in difficult cases. Depression is also a clinical diagnosis and is common and persistent symptom in Parkinson's disease. Dementia is very often in Parkinson's disease, but usually not at the first stages. The treatment of each of the above symptoms is difficult and a lot of times individualized. CASE PRESENTATION: Female 64 years old patient with history of hypothyroidism, depression and anxiety disorder was examined at outpatient Memory and Dementia clinic of 3(rd )Department of Neurology. The patient's major problems were functional and cognitive decline, severe extrapyramidal symptoms and depression. According to UKPDS Brain Bank criteria the patient had bradykinesia, muscular rigidity, postural instability and rest tremor present with unilateral onset of the symptoms affecting left side most and progressive course. The modified Hoehn and Yahr scale was 3: mild to moderate bilateral disease; some postural instability; physically independent. The symptoms remained during nine months follow up, despite the pharmaceutical treatment. Nine months later, the patient made an attempt to suicide. Firstly, she was transferred to intensive care department with 2(nd )degree burns and respiratory problems, then she was hospitalized at the Burn Unit and afterwards at the Psychiatric clinic. One month later the patient had no depression, a clear reduction of the extrapyramidal symptoms, functional and cognitive improvement. CONCLUSION: An astonishing improvement occurred after the threat of life. Two years after the attempt to suicide, the depressive symptoms remain in remission and functional and cognitive status is normal. The extrapyramidal symptoms have disappeared.