[A 56-year-old XXXX with @entity304 and @entity303 with the age of onset at 41 years].

@entity1 @entity18776 @entity2003 @entity304 @entity303 @entity910 @entity1833 @entity400 @entity2146 @entity1576 @entity1282
We report a 56-year-old @entity1 with @entity304 and @entity303 who died of @entity1576 . The @entity1 was well until the age of 41 when she noted insidious onset of difficulty in moving around. Soon after, she noted @entity400 in both her hands and gait disturbance. She received stereotaxic right thalamotomy when she was 46-year-old; after thalamotomy, improvement was noted in her @entity400 , @entity2003 , and in gait. However, a few months later, she started to experience motor fluctuations with worsening of her symptoms in the afternoon. This worsening was temporarily relieved by increasing her levodopa/ @entity18776 dose. She started to show @entity1833 and @entity2146 when she was 54-year-old. Her symptoms had progressively become worse with marked motor fluctuations and she was admitted to our hospital when she was 56-year-old. On admission, she was alert and general physical examination was unremarkable. Neurologic examination revealed that she was disoriented to time and place; memory was markedly disturbed and calculation was poor. Hasegawa @entity303 scale was 7/30. Higher cerebral functions appeared intact. She showed masked face, small voice, and some @entity1282 . Other cranial nerves were intact including ocular movements. She was unable to walk by herself; when supported she walked in small steps with marked disturbance in the righting reflex. Mixed @entity2003 and Gegenhalten was noted in her four limbs and in the neck. @entity400 was absent. She showed marked @entity910 .(ABSTRACT TRUNCATED AT 250 WORDS)
