Case 15: The Shaky Situation

[Hrishikeshmed]

A 65-year-old retired schoolteacher presents to the neurology clinic with complaints of a resting tremor in his right hand that has progressively worsened over the past year. His wife notes that he has become slower in his movements, often taking longer to get dressed and walk short distances. On examination, the patient demonstrates cogwheel rigidity in both upper limbs, a shuffling gait, and masked facial expressions. He denies any history of stroke, head trauma, or psychiatric illness. There is no significant family history of neurological disorders. Given his clinical presentation, what is the most likely diagnosis, and which neurotransmitter imbalance underlies his symptoms?