436 - Corticobasal Degeneration: Navigating Diagnostic Complexity in the Rehabilitation Setting

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JS

Jasmine Sidhu, MD

Resident Physician/ MD
Larkin Community Hospital
Miami, Florida, United States

Co-Author(s)

AH

Arshi Handa, MD

Resident physician
Larkin Community Hospital, Palm Springs Campus
Doral, Florida, United States
EC

Emiliano Curia, MD

Chief Resident
Larkin Community Hospital, Palm Springs Campus
Miami, Florida, United States
DV

Daniel R. Villanueva Toby, DO

Resident Physician
Larkin Community Hospital South Miami
Hialeah, Florida, United States

Case Diagnosis: Corticobasal degeneration (CBD) is a rare neurodegenerative disorder that poses diagnostic and treatment challenges. Traditionally, it manifests as an asymmetric movement disorder with akinesia, rigidity, dystonia, myoclonus, apraxia, and alien-limb phenomena. As an atypical parkinsonian syndrome, CBD exhibits both distinct and overlapping features with Parkinson's disease, as well as other atypical parkinsonian disorders such as PSP and multiple system atrophy.

Case Description: An 84-year-old Hispanic male with a history of dementia and psychosis underwent rehabilitation due to altered mental status and self-inflicted finger amputation. He had anxiety, psychosis, and cognitive impairment and exhibited fixated tendencies. Initial neurological exams showed Parkinsonian features with upper extremity rigidity. A psychiatric evaluation revealed cognitive deficits but no hallucinations. He was diagnosed with dementia with psychosis and Gegenhalten rigidity. Neurorehabilitation found positive frontal release signs, including palmomental, glabellar, and grasp reflexes. Considering Parkinson's disease and CBD, CBD was suspected due to limb rigidity, orobuccal apraxia, cognitive deficits, and possible alien limb phenomena. Treatment with levodopa-carbidopa had no effect, strengthening the CBD suspicion. A multidisciplinary approach focused on cognitive-linguistic skills, improving mobility, and enhancing communication.

Discussions: Differentiating CBD from other parkinsonian disorders is crucial in rehabilitation, enabling customized treatment, monitoring, research participation, counseling, and cost-efficiency. Challenges emerge due to the absence of widely accepted criteria, biomarkers, and CBD's diverse presentations. Ongoing research is vital to improve diagnosis and comprehend this complex disorder.

Conclusions: In summary, accurately distinguishing Parkinson's disease from other parkinsonian conditions is crucial in clinical practice. This differentiation is essential for several reasons: it guides tailored treatment, enables disease monitoring, supports research participation, offers targeted patient support, reduces unnecessary costs, and allows for genetic counseling when relevant. A precise diagnosis empowers healthcare professionals to optimize patient care, enhance outcomes, and contribute to advancements in managing parkinsonian disorders.