Introduction
The Fall related complications are commonly observed in Parkinson’s disease (PD) patients. The risks of fallings are disease duration, mobility, dyskinesia, bradykinesia, wearing off phenomena, cognitive impairment. The risk of falling is the highest when patients reach Hoehn and Yahr(H&Y) stage 2.5 to 3, when balance becomes impaired but patients are still sufficiently mobile to be at risk of falling. In order to take the best possible care for aggravation of fall related complications, it is critical that caregiver to take quick actions to prevent further complication.
We report the case that mild soft tissue trauma after fall lead to rhabdomyolysis with peripheral neuropathy, because neglected PD patient was lying face down and unconscious for hours.
Case
A 69-year old woman with parkinson’s disease referred to ER. At home, She was lying on the floor with her leg pinned under the electric pan, just before she visited ER. She was evaluated as grade 3 of H&Y stage, had some postural instability and physically independent. She presented with right lower extremity pain. 10cm x 5cm size of abrasion at right tibialis anterior, 10 x 7cm size of round shape of abrasion at right popliteal fossa were found. Examination revealed weakness of the right hip flexor (Medical Research Council [MRC] 1/5) and knee extensor(MRC 2/5), ankle dorsiflexor(MRC 1/5). There was sensory loss in the right anterolateral leg. Urine color was dark yellow. CK, LDH, CK-MB and myoglobin levels were increased to 15790 IU/L, 471 IU/L, 77.3 ng/ml and 3000 ng/ml, respectively. In bone scan, abnormal soft tissue uptake was seen in the areas of right proximal thigh and right proximal tibia. In 3D angio CT, swelling of right lower extremity with Hematoma was seen at anterior and posterior parts of leg. These findings were compatible with rhabdomyolysis. Electromyography revealed peripheral neuropathy of common peroneal nerve at injury site.
After one month of strengthening and endurance exercise with electrical stimulation therapy, she showed gradual improvement but no significant change in dorsiflexion. The right hip flexor (MRC 3/5) and knee extensor(MRC 3/5), ankle dorsiflexor(MRC 1/5) were measured.
Conclusion
we have caution that safety eviroment must be prepared to PD patient for reducing risk of falling.
To prevent of falls and take immediate action to avoid further aggravation of fall related complications, the real-time monitoring system for PD patients is positively necessary.
Key Words:
Peripheral neuropathy, Parkinson Disease, Risk of falling |
