Camptocormia: As the First Sign of Parkinson's Disease

Camptocormia is defined as an abnormal flexion of the thoracolumbar spine and trunk that appears while standing or walking 1 .A severe trunk flexion was noted in the original description of Parkinson disease (PD), and more recently has been described in other basal ganglia diseases, dystonia, and neuromuscular disorders.A recent epidemiological study revealed that this is a relatively common symptom and seems to be related to the clinical severity of PD 2 .Here, we report a patient who had a marked camptocormia prior to the onset of clinical triad of Parkinsonism. CASEA 77-year-old woman was admitted to our hospital with complaints of a right side tremor at rest, bradykinesia and gait disturbance.The patient had been well until about four months earlier, when she began to notice a bend in her spine that was present while standing or walking.This abnormal contraction was relieved on sitting and supine position.Soon thereafter, she felt her gait was mildly uncomfortable.At that time, the patient visited a private medical clinic and was diagnosed as kyphosis due to aging process.Although a formal neurological examination was not recorded in the medical record, there was no mentioned about tremor, bradykinesia, or rigidity to suggest Parkinsonism.Two months before admission, the patient developed a masked face, dysarthria, bradykinesia, and right hand rest tremors.Over a period of weeks, the patient began to stand without assistance and could take a few steps, bent forward with short step and stride.The patient reported no history of spine trauma, surgical incidents, or neurological diseases.There was no exposure to neuroleptic medications.On examination, the patient was oriented to place and people, but had difficulty copying, calculating, and maintaining attention.A neuropsychological investigation using Seoul Neuropsychological Screening Battery 3 showed a mild memory impairment, reduced psychomotor speed, and visuospatial dysfunction.In addition, the patient exhibited hypomimia and mild dysarthria.All four limbs exhibited bradykinesia and rigidity.The patient stood on a narrow base, and her stride was reduced with decreased arm swing bilaterally.The posture was markedly stooped: nearly 60°with painless forward trunk flexion while standing and walking, but the flexed posture was alleviated in the sitting position (see the supplementary video online).On the modified Hoehn & Yahr staging test, the patient scored 2.5 for the non-medicated state and the result of the Unified Parkinson's Disease Rating Scale (UPDRS) total was 37.The following laboratory test results were negative or normal: biochemical and hematologic profiles, thyroid function testing,

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