Name: Alireza Afzali Yazdi
Sex: Male
Country: Iran
Age: 54 years
Diagnoses: Parkinson syndrome
Admission Date: 2013-05-11
Days Admitted to the Hospital: 28

Medical History:
The patient suffered from a tremor of the right hand when he wrote 7 years ago. This was accompanied with pain in the wrist. There was no obvious micrographia sign. The patient didn't receive any treatment. The tremor of the right hand was aggravated 6 years ago. He felt obvious rigidity when he wears clothes or raises both upper limbs. This was accompanied with bradykinesia of both upper limbs. The patient went to local hospital and was diagnosed with Parkinson disease. He started took Levodopa for therapy. The tremor of the right hand was alleviated slightly after taking the medications. But other symptoms had no improvement. The patient suffered from less expression in the recent 2 months. He had more blinking actions. He has a limp occasionally when he walks. He started taking Sifrol for therapy, but the effect was not good. Before the treatment, the patient had tremor of the right hand, bradykinesia of both upper limbs and rigidity sensation. He had a limp occasionally when he walks. He also had less expression and too many blink actions.

Nervous System Examination:
Alireza Afzali Yazdi was alert but his speech was vague. His memory, calculation abilities, and orientation were normal. He had masked face and less facial expression. He had too many eye winks. Both pupils were equal in size and round, the diameter was about 3.0mm. Both pupils were sensitive to light stimulus. The convergence ability was poor, with no obvious nystagmus. The forehead wrinkle pattern and bilateral nasolabial grooves were symmetrical. There was obvious tremor in the tongue. The stretch of the tongue was limited, the tongue could only reach the lip. The muscles that raise the soft palate were strong. The uvula had no deflection. He turned his head slowly. Both upper limbs also acted slowly. Right upper limb was more severe, this was accompanied with static pill-rolling tremor. The muscle strength of the four limbs was level 5. He wrote slowly and had lowercase sign. He had intermittent difficulty to start when he walked. The walking speed was still ok. There was no arm swing during walk. The muscle tone of both waist and right lower limb was increased intermittently, right waist was more severe. The muscle tone of other limbs was normal. Bilateral biceps reflex, triceps reflex, radioperiosteal reflex, patellar tendon reflex and Achilles tendon reflex were normal. Bilateral Hoffmann sign was negative. Bilateral Rossilomo sign was negative. Bilateral sucking reflex was negative. Bilateral palm jaw reflex was negative. Bilateral Babinski sign was negative. The patient had normal deep sensation, shallow sensation and fine sensation. The right side did the digital opposition test and rapid rotation test in a clumsy manner. The right side did the finger-nose-test in a stable manner. The left side did the digital opposition test, rapid rotation test and the finger-nose-test in a stable manner. He did the heel-knee-tibia test in a stable manner. The Romberg sign was positive. The meningeal irritation was negative.

Treatment:
Alireza Afzali Yazdi received all of the relevant examinations. He was diagnosed with Parkinson syndrome. He received anti-Parkinson's treatment and anti-free radical treatment. He was also given treatment in order to expand the blood vessels to improve the blood-supply to the damaged brain, nourishment for the neurons and protect gastric mucosa. He also received treatment for nerve regeneration. This was combined with physical rehabilitation training.

Post-Treatment:
Alireza Afzali Yazdi's speech is cleared than before. His masked face is not as severe. He has more nature facial expression. The eye wink is more nature than before. The tongue can stretch out lips 1.5cm distance. He still has a slight tremor in his tongue. He can turn his head rapidly. There is no tremor in his lower jaw. The right hand has slight static tremor. There is no start difficulty when he walks. The walking speed can be controlled. He swings arms harmonically. He can turn round, turn over and change body position quickly. He writes smoothly. The muscle tone of limbs was normal. Both sides did the rapid rotation test and the digital opposition test flexibly. Both sides did the finger-nose-test and the heel-knee-tibia test in a stable manner. There were no signs of meningeal irritation.