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Medical Humanities

Trips and Falls

Mazyar Malakouti, MD and Sayed K. Ali MD, FACP

November 16, 2015

A 47 year old right handed female with a history of controlled diabetes presented to our institution with recent falls.  For the last two months, she had noticed a change in her gait that contributed to her falls.  She denied any other constitutional symptoms including palpitations, diaphoresis, fevers, headaches, tetany, fatigue, loss of smell or syncope.  She had normal vital signs of presentation.  Her urinalysis, complete metabolic panel (including ionized calcium), complete blood count, thyroid stimulation hormone, parathyroid hormone, ceruloplasmin, vitamin B12 levels were all within normal range.  Analysis of her cerebrospinal fluid (CSF) was unremarkable.  Her heavy metal and mineral screen was negative. She was alert and oriented to self, place and time.  Her speech was coherent, writing clear and she easily followed verbal commands without hesitation or arrest. Cranial nerves II – XII were grossly intact.  She had normal strength, sensation and range of motion in both her upper and lower extremities.  Deep tendon reflexes were brisk. She had no involuntary movements with normal coordination.  Her gait was unstable (small step gait) and she needed frequent support with ambulation.  A brain CT scan showed significant calcification of the bilateral basal ganglia (Figure 1). 

Trips and Falls

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About the Authors: 

Mazyar Malakouti, MD 
PGY 2 – Internal Medicine Resident
University of Texas Health Science Center, San Antonio TX

Sayed K. Ali MD, FACP
Faculty, Internal Medicine/Palliative Care
Department of Medicine
Orlando VA Medical Center