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A correction has been published: N Engl J Med 1994;330(6):448.

Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 329:1560-1567 November 18, 1993 Number 21
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Case 46-1993— A 75-Year-Old Man with Right-Sided Rigidity, Dysarthria, and Abnormal Gait
Robert G. Feldman, and Ann C. McKee

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Presentation of Case

A 75-year-old right-handed man was referred to the Movement Disorders Unit of this hospital because of right-sided rigidity, dysphagia, dysarthria, and an impaired gait.

The patient's health had been stable until two years earlier, when his family began to observe episodes of "unresponsiveness." A magnetic resonance imaging (MRI) scan of the brain obtained elsewhere (Figure 1, 2, and 3) showed atrophy and hypointense areas in the basal ganglia on T2-weighted images considered consistent with calcifications or iron deposits. No additional episodes occurred after phenytoin treatment. One year later the patient began to lose his balance frequently and . . . [Full Text of this Article]

Differential Diagnosis

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Dr. Robert G. Feldman's Diagnosis

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