A 61-year-old Diabetic And Alcoholist Male With Bilateral

Abstract

A 61-year-old white right-handed man was admitted because of recent loss of weight and difficulty in swallowing solid foods. There was gradually progressive apathy, postural instability with falls backwards and cognitive deficit. His past history included controlled diabetes mellitus and arterial hypertension, tobacco smoking and heavy alcoholism. During the last two years, an unexplained bilateral contraction developed in some of his fingers. He was not a manual worker nor a guitar or piano player, and denied previous hand trauma or similar disturbance in members of his family. Physical examination confirmed postural instability and revealed vertical gaze palsy, and the suspicion of progressive supranuclear palsy (PSP) was confirmed, based on clinical data and the study of brain images. Moreover, there was bilateral contraction of the middle, ring and little fingers, and thickened linear structures were palpated over the third, fourth and fifth flexor tendons on both palms. Furthermore, the patient was not able to lay his palms flat on a tabletop; and conspicuous hypotrophy of the lumbrical and interosseus muscles was observed (Figure 1). The evaluation of the shoulders, plantar and genital regions showed no abnormality. Laboratory tests were unremarkable, and specific studies were made to clear the hand changes. The patient was treated with conservative clinical, nutritional, and physiotherapy procedures, before being referred for specialized treatment and outpatient surveillance.What is your diagnosis?