# Case 15: The Shaky Situation **URL:** \ **Category:** MBBS\ **Tags:** neetpg, medical, mbbs, futuredoctors\ **Created:** [June 7, 2025, 5:34pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870 "2025-06-07T17:34:24Z")\ **Posts on this page:** 9\ **Page:** 1
**Author:** ![Hrishikeshmed](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/hrishikeshmed/32/346_2.png) [@Hrishikeshmed](https://www.medboundhub.com/u/Hrishikeshmed)\ **Post date:** [June 7, 2025, 5:34pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/1 "2025-06-07T17:34:24Z")
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? ---
**Author:** ![Soumya](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/soumya/32/354_2.png) [@Soumya](https://www.medboundhub.com/u/Soumya)\ **Post date:** [June 8, 2025, 10:49am UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/2 "2025-06-08T10:49:38Z")
depending on the symptoms , it can be Parkinson’s disease ---
**Author:** ![medha](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/medha/32/476_2.png) [@medha](https://www.medboundhub.com/u/medha)\ **Post date:** [June 8, 2025, 12:10pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/3 "2025-06-08T12:10:38Z")
Dopamine is the neurotransmitter that leads to this when its levels decrease in the substantia nigra in our brains… so the smooth movements of hands are affected first… More the deficiency, worse the movements. To control these, levodopa carbidopa therapy is prescribed… Parkinson’s disease is the likely diagnosis. ---
**Author:** ![Manisha](https://avatars.discourse-cdn.com/v4/letter/m/6f9a4e/32.png) [@Manisha](https://www.medboundhub.com/u/Manisha)\ **Post date:** [June 8, 2025, 12:33pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/4 "2025-06-08T12:33:49Z")
Parkinson’s disease, Dopamine ---
**Author:** ![Jaideep](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/jaideep/32/300_2.png) [@Jaideep](https://www.medboundhub.com/u/Jaideep)\ **Post date:** [June 8, 2025, 1:40pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/5 "2025-06-08T13:40:58Z")
Diagnosis: Parkinson’s disease (most likely Idiopathic) Deficiency of Dopamine due to degeneration of neurons of Striata Niagra Pars Compacta \> Leading to Uninterrupted Signals from Basal Ganglia (GPI) ---
**Author:** ![Aadish](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/aadish/32/308_2.png) [@Aadish](https://www.medboundhub.com/u/Aadish)\ **Post date:** [June 9, 2025, 6:04am UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/6 "2025-06-09T06:04:16Z")
The most likely diagnosis is Parkinson’s disease. Symptoms include resting tremor, bradykinesia, and rigidity. Cogwheel rigidity, shuffling gait, and masked facies are characteristic. Dopamine deficiency in the basal ganglia underlies the symptoms. This deficiency disrupts normal motor control. Parkinson’s disease is a neurodegenerative disorder. Dopamine replacement therapy is a common treatment approach. ---
**Author:** ![Manas\_Kakkar](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/manas_kakkar/32/285_2.png) [@Manas\_Kakkar](https://www.medboundhub.com/u/Manas_Kakkar)\ **Post date:** [June 9, 2025, 12:37pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/7 "2025-06-09T12:37:02Z")
Its **Parkinson’s Disease**. His tremor, slowed movements, and rigidity are classic signs, primarily due to a **lack of dopamine** in the brain. It’s a challenging condition ---
**Author:** ![kirtikaverma](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/kirtikaverma/32/395_2.png) [@kirtikaverma](https://www.medboundhub.com/u/kirtikaverma)\ **Post date:** [June 9, 2025, 6:09pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/8 "2025-06-09T18:09:15Z")
Parkinson’s disease most likely! Dopamine deficiency in the substantia nigra pars compacta of the basal ganglia. Diagnosis can be done,resting tremor ,bradykinesia,cogwheel rigidity etc. ---
**Author:** ![Hbdoctor](https://yyz1.discourse-cdn.com/flex033/user_avatar/www.medboundhub.com/hbdoctor/32/571_2.png) [@Hbdoctor](https://www.medboundhub.com/u/Hbdoctor)\ **Post date:** [June 9, 2025, 11:17pm UTC](https://www.medboundhub.com/t/case-15-the-shaky-situation/2870/9 "2025-06-09T23:17:11Z")
Remember why Levodopa and Carbidopa are used together to treat Parkinsonism. #CarbiDopa #LevoDopa