107FALLS: THINK UNCONVENTIONALLY

Abstract

Case Study: A 79-year-old previously fully independent male presented initially to Geriatric Medicine clinic with poor balance, back and leg pain with stiffness progressing over five months. Whilst awaiting investigations he was admitted to hospital a month later following a fall down stairs, and with a history of rapid decline, recurrent falls and reduced activities of daily living due to reduced dexterity. There were no hallucinations or memory decline reported. He was found to have increased tone on left side but no tremor or bradykinesia. Other neurological examinations were normal but he had marked dyspraxia of his left upper limb. His Montreal Cognitive Assessment score was 8/30. CT head showed small vessel disease. Initial clinical impression was possible Parkinson's Plus syndrome and a neurologist review was sought where he was diagnosed with Corticobasal Syndrome. Supportive management was provided. Discussion(s): Corticobasal syndrome is a rare sporadic progressive neurological disorder with onset typically between 50 to 70 years old. Classic symptoms are asymmetric rigidity with apraxia and akinesia. Cognitive symptoms are common including visual-spatial impairment, impairments in executive functioning and dementia1. It can progress over six to eight years and death usually occurs due to complications of immobility2. Management is directed to symptom control2. Multidisciplinary input such as physiotherapy, occupational therapy and speech and language therapy is beneficial3. Distinguishing corticobasal degeneration from other similar neurodegenerative disorders is difficult and with fairly rapid progression it is important to consider this as a diagnosis to aid in management of symptoms and anticipatory care planning4.