Assessment

LONG CASE : 34 year old male patient resident of Nalgonda came to the hospital with CHIEF COMPLAINTS: Involuntary movements of  upper limbs since 4 years Stiffness of all 4 limbs since 4 years Slowness of movements since 4 years  Involuntary movements of lower limbs since 3 years HISTORY OF PRESENTING ILLNESS:  Patient was apparently asymptomatic 4 years back then he developed involuntary movements which developed in right upper limb since 4 years and after 6 months of initiation of right side developed to Left upper limb which was gradual in onset, occurs at rest  since 3 years developed  in lower limbs also which were subsided by voluntary movements and also subsides during sleep as told by family members.  Involuntary  movements not decreased with levodopa medication.  He has history of difficulty in initiation of movements , to start there is clumsiness of movements and now difficulty to perform his day to day activities like mixing of food , brushing teeth Difficulty to start