A stridorous woman

CASE PRESENTATION A 73-year-old woman was referred to our movement disorders clinic for evaluation of tremor. Her symptoms had started 1 year prior to presentation with a postural tremor as well as an intermittent rest tremor of her right hand. These symptoms worsened over time and affected her handwriting. She was treated with dopaminergic agonists in adequate doses, with no significant benefit, which were discontinued due to side-effects. She had dysphonia, preceding the onset of tremor by several years, that was initially diagnosed as spasmodic dysphonia. Over the prior 3 months she had had more trouble with her voice and difficulty breathing, which was stridorous at rest. She had experienced urinary stress incontinence for 6 years and urge incontinence for the past 1 year. She denied difficulty walking or falls, but had trouble standing from the sitting position and rare incidents of freezing while walking. She also complained of fatigue, and trouble swallowing her pills. She had no history of infection, toxin exposure, or use of medications known to cause a parkinsonian syndrome and no family history to suggest a hereditary neurodegenerative disease.