Parkinson's disease pathology US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Parkinson's disease pathology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Parkinson's disease pathology US Medical PG Question 1: A 70-year-old man is accompanied by his wife to the primary care clinic for hand tremors. He states that he first noticed the tremor of his left hand 1 year ago. Since then, the tremor has been worsening and now he can hardly relax when trying to read. His wife says that she is also worried about his memory. She had to take over the finances several weeks ago after learning that he had forgotten to pay the bills for the past few months. The patient’s medical history is significant for hypertension. He takes aspirin and amlodipine. His mother had schizophrenia. The patient drinks 1-2 beers a night and is a former cigar smoker. On physical examination, he speaks softly and has reduced facial expressions. He has a resting tremor that is worse on the left, and he resists manipulation of his bilateral upper extremities. Which of the following is the most likely diagnosis?
- A. Dementia with Lewy bodies
- B. Parkinson disease (Correct Answer)
- C. Essential tremor
- D. Progressive supranuclear palsy
- E. Tardive dyskinesia
Parkinson's disease pathology Explanation: ***Parkinson disease***
- The patient exhibits classic symptoms of **Parkinson disease**, including a **unilateral resting tremor** (left hand), **bradykinesia** (soft speech, reduced facial expressions), and **rigidity** (resists manipulation of upper extremities).
- The associated **cognitive decline** (memory issues, forgetting to pay bills) is also common in Parkinson disease, developing often after the motor symptoms.
*Dementia with Lewy bodies*
- While **cognitive fluctuations**, **visual hallucinations**, and **Parkinsonism** can occur in Dementia with Lewy bodies, the **dementia** typically precedes or coincides with the motor symptoms, unlike the progression seen here where motor symptoms appeared first.
- Distinctive features like **recurrent visual hallucinations** and **fluctuating cognition** are not explicitly mentioned as prominent in this case.
*Essential tremor*
- **Essential tremor** is typically an **action tremor** that worsens with movement and improves at rest, whereas this patient has a **resting tremor**.
- It usually affects both sides of the body symmetrically and is not typically associated with **bradykinesia**, **rigidity**, or **cognitive decline**.
*Progressive supranuclear palsy*
- **Progressive supranuclear palsy** is characterized by **early postural instability** and falls, **supranuclear ophthalmoplegia** (especially vertical gaze palsy), and a more **symmetric Parkinsonism** that is often resistant to levodopa.
- The predominant **asymmetric resting tremor** and **cogwheel rigidity** observed in this patient are less typical of this condition.
*Tardive dyskinesia*
- **Tardive dyskinesia** is a unique movement disorder characterized by **involuntary, repetitive, and purposeless movements**, usually of the face (e.g., grimacing, tongue protrusion, lip smacking) and limbs.
- It results from **chronic dopamine receptor blockade** typically due to antipsychotic medications, which the patient is not taking, and presents differently from the patient's symptoms.
Parkinson's disease pathology US Medical PG Question 2: A 70-year-old woman is brought to the office after her nurse noticed her being apathetic, easily distracted, and starting to urinate in bed. Her medical history is relevant for hypertension, under control with medication. Physical examination reveals a blood pressure of 138/76 mm Hg, a heart rate of 70/min, and a respiratory rate 14/min and regular. On neurological examination, she has a broad-based shuffling gait, and increased muscle tone in her limbs that is reduced by distracting the patient. There is decreased coordination with exaggerated deep tendon reflexes, decreased attention and concentration, and postural tremor. Which of the following additional features would be expected to find in this patient?
- A. Degeneration of the substantia nigra pars compacta
- B. Caudate head atrophy
- C. Accumulation of Lewy bodies in cortical cells
- D. Dilation of the ventricular system (Correct Answer)
- E. Accumulation of amyloid plaques and neurofibrillary tangles in the cerebral cortex
Parkinson's disease pathology Explanation: ***Dilation of the ventricular system***
- The patient presents with a classic triad of **gait apraxia** (broad-based, shuffling gait), **dementia** (apathy, distractibility, decreased attention and concentration), and **urinary incontinence**, which are the hallmark symptoms of **Normal Pressure Hydrocephalus (NPH)**. NPH is characterized by **ventricular dilation without increased intracranial pressure**.
- Other features like **increased muscle tone that reduces with distraction** (frontal release sign), **exaggerated deep tendon reflexes**, and **postural tremor** further support the diagnosis of NPH, as these are often seen due to involvement of frontal lobe pathways secondary to ventricular enlargement.
*Degeneration of the substantia nigra pars compacta*
- This is characteristic of **Parkinson's disease**, which typically presents with a rest tremor, bradykinesia, rigidity, and postural instability, but not typically with prominent early dementia and urinary incontinence in this combined clinical picture.
- While Parkinson's can cause gait disturbance, the specific combination of symptoms (dementia, incontinence, and gait apraxia) points away from primary Parkinson's as the most likely diagnosis.
*Caudate head atrophy*
- **Caudate head atrophy** is a hallmark finding in **Huntington's disease**, which is characterized by chorea, psychiatric symptoms, and progressive cognitive decline.
- The patient's symptoms, particularly the broad-based shuffling gait and urinary incontinence, are inconsistent with the typical presentation of Huntington's disease.
*Accumulation of Lewy bodies in cortical cells*
- This is a pathological feature of **Lewy body dementia (LBD)**. While LBD presents with dementia and Parkinsonian features, it also typically includes **recurrent visual hallucinations** and **fluctuations in attention and alertness**, which are not specified in this patient's presentation.
- The patient's dominant features of gait apraxia and urinary incontinence along with dementia are more indicative of NPH.
*Accumulation of amyloid plaques and neurofibrillary tangles in the cerebral cortex*
- These are the pathological hallmarks of **Alzheimer's disease**, which primarily presents with progressive memory loss, executive dysfunction, and other cognitive deficits.
- While dementia is a feature in this patient, the prominent gait disturbance and urinary incontinence are not typical early or dominant features of Alzheimer's disease.
Parkinson's disease pathology US Medical PG Question 3: A 71-year-old man presents to his primary care physician because he is increasingly troubled by a tremor in his hands. He says that the tremor is worse when he is resting and gets better when he reaches for objects. His wife reports that he has been slowing in his movements and also has difficulty starting to walk. His steps have been short and unsteady even when he is able to initiate movement. Physical exam reveals rigidity in his muscles when tested for active range of motion. Histology in this patient would most likely reveal which of the following findings?
- A. Intracellular hyperphosphorylated tau
- B. Large intracellular vacuoles
- C. Amyloid beta plaques
- D. Perivascular inflammation
- E. Alpha-synuclein (Correct Answer)
Parkinson's disease pathology Explanation: ***Alpha-synuclein***
- The patient's symptoms of a **resting tremor** that improves with action, **bradykinesia** (slowed movements, difficulty initiating walking, short steps), and **rigidity** are classic for **Parkinson's disease**.
- Histologically, Parkinson's disease is characterized by the presence of **Lewy bodies**, which are intracellular inclusions comprised primarily of aggregated **alpha-synuclein** protein, particularly in the substantia nigra.
*Intracellular hyperphosphorylated tau*
- **Hyperphosphorylated tau protein** forms **neurofibrillary tangles** and is characteristic of **Alzheimer's disease** and other tauopathies (e.g., frontotemporal dementia), which typically present with cognitive decline rather than primarily motor symptoms as seen here.
- While Parkinson's disease can have co-existing tau pathology, it is not the primary histological hallmark for the motor symptoms described.
*Large intracellular vacuoles*
- The presence of **large intracellular vacuoles** within neurons is characteristic of **spongiform encephalopathies** (e.g., Creutzfeldt-Jakob disease), which present with rapidly progressive dementia, myoclonus, and ataxia.
- This finding is not associated with the classic motor symptoms of Parkinson's disease.
*Amyloid beta plaques*
- **Amyloid beta plaques** (extracellular deposits of amyloid-beta protein) are a hallmark of **Alzheimer's disease**, which primarily manifests with progressive cognitive impairment and memory loss.
- These plaques are not the primary histological feature of Parkinson's disease.
*Perivascular inflammation*
- **Perivascular inflammation** is typically seen in **inflammatory or demyelinating diseases** of the central nervous system, such as **multiple sclerosis** or **encephalitis**.
- This finding is not characteristic of neurodegenerative disorders like Parkinson's disease, which are instead marked by protein aggregation and neuronal loss.
Parkinson's disease pathology US Medical PG Question 4: A 53-year-old man is brought to the physician by his wife because of strange behavior and emotional outbursts for the past 6 months. He was previously healthy and physically active, but he recently started binge-eating candy and stopped exercising. He was fired from his job for inappropriate behavior after he undressed in the office and made lewd remarks to several female coworkers. He claims there is nothing wrong with his behavior. On mental status examination, he is alert and irritable but cooperative. Short-term recall is normal but he has some word-finding difficulties. Babinski reflex is positive bilaterally. This patient's symptoms are most likely due to a degenerative process in which of the following regions of the brain?
- A. Frontal cortex (Correct Answer)
- B. Corona radiata
- C. Hippocampus
- D. Caudate nucleus
- E. Substantia nigra
Parkinson's disease pathology Explanation: ***Frontal cortex***
- This patient's symptoms, including **behavioral disinhibition** (inappropriate sexual behavior, emotional outbursts, undressing in the office), **changes in eating habits** (binge-eating candy), **loss of empathy**, and **lack of insight**, are classic presentations of **frontotemporal dementia (FTD)**.
- **Word-finding difficulties** and the **positive Babinski reflex** bilaterally further support a neurodegenerative process affecting the **frontal lobes**, which are crucial for executive function, social conduct, and language.
*Corona radiata*
- The **corona radiata** consists of white matter tracts connecting the cerebral cortex to the brainstem and spinal cord.
- While damage here can cause motor and sensory deficits, it is **less directly involved in the primary behavioral and personality changes** seen in this patient compared to the frontal cortex.
*Hippocampus*
- The **hippocampus** is primarily involved in **memory formation**, particularly **short-term and declarative memory**.
- This patient's **short-term recall is normal**, making the hippocampus an unlikely primary site of degeneration for the presented symptoms.
*Caudate nucleus*
- The **caudate nucleus** is part of the **basal ganglia** and is involved in motor control, learning, and cognitive functions.
- While atrophy can occur in some neurodegenerative diseases like Huntington's disease, the predominant symptoms here are **behavioral and executive dysfunction**, not typical of isolated caudate pathology.
*Substantia nigra*
- The **substantia nigra** is a midbrain structure crucial for **motor control** due to its role in dopamine production.
- Degeneration of the substantia nigra is characteristic of **Parkinson's disease**, leading to bradykinesia, rigidity, and tremor, which are not the primary features described here.
Parkinson's disease pathology US Medical PG Question 5: A 65-year-old man was picked up by the security personnel for voiding urine and defecating at an inappropriate place in the community. On questioning, he was making offensive remarks and behaving inappropriately. On physical examination, the physician observed signs of cognitive impairment and amnesia. Initial urine drug screen is negative for any drugs of abuse. Which is the most likely pathological finding present in this patient?
- A. Drug abuse
- B. Amyloid plaques
- C. Lewy bodies
- D. Pick bodies (Correct Answer)
- E. PrPSC Sheets
Parkinson's disease pathology Explanation: ***Pick bodies***
- The patient presents with **disinhibition** (inappropriate voiding, defecating in public), **offensive remarks**, and **inappropriate behavior**, which are hallmarks of **frontotemporal dementia (FTD)**, specifically the behavioral variant.
- **Pick bodies** are aggregates of **tau protein** found in neurons of the frontal and temporal lobes, characteristic of Pick's disease, a subtype of FTD.
- Behavioral variant FTD characteristically presents with **personality changes**, **loss of social awareness**, and **executive dysfunction** before significant memory impairment.
*Drug abuse*
- While drug abuse can lead to inappropriate behavior and neuropsychiatric symptoms, the **negative urine drug screen** makes this diagnosis unlikely.
- Drug abuse typically doesn't present with the progressive cognitive decline and specific behavioral pattern seen here.
*Amyloid plaques*
- **Amyloid plaques** (along with neurofibrillary tangles) are characteristic pathological findings in **Alzheimer's disease**, which typically presents with **memory impairment** as the predominant initial symptom.
- Although Alzheimer's disease can lead to behavioral changes in later stages, the **prominent early disinhibition** and preserved memory (relative to behavioral changes) are more typical of FTD than Alzheimer's.
*Lewy bodies*
- **Lewy bodies** are associated with **dementia with Lewy bodies (DLB)** and **Parkinson's disease dementia**.
- DLB is characterized by **fluctuating cognition**, **visual hallucinations**, and **parkinsonism** (rigidity, bradykinesia), which are not the predominant features in this patient's presentation.
*PrPSC Sheets*
- **PrPSC sheets** refer to the misfolded prion protein found in **prion diseases** such as Creutzfeldt-Jakob disease (CJD).
- CJD typically manifests with **rapidly progressive dementia** (over weeks to months), **myoclonus**, and **cerebellar signs**, with a much faster progression than the clinical picture suggested here.
Parkinson's disease pathology US Medical PG Question 6: An 81-year-old woman presents to your office accompanied by her husband. She has been doing well except for occasional word finding difficulty. Her husband is concerned that her memory is worsening over the past year. Recently, she got lost twice on her way home from her daughter’s house, was unable to remember her neighbor’s name, and could not pay the bills like she usually did. She has a history of hypertension and arthritis. She has no significant family history. Her medications include a daily multivitamin, hydrochlorothiazide, and ibuprofen as needed. Physical exam is unremarkable. Which of the following is associated with an increased risk of this patient’s disease?
- A. Presenilin-2
- B. ApoE2
- C. ApoE4 (Correct Answer)
- D. Female gender
- E. Advanced age (>85 years)
Parkinson's disease pathology Explanation: ***Correct: ApoE4***
- The patient's symptoms (progressive memory loss, getting lost on familiar routes, difficulty with routine tasks like paying bills) in an 81-year-old suggest **Alzheimer's disease**.
- The **ApoE4 allele** is a well-established genetic risk factor for **late-onset Alzheimer's disease**, significantly increasing the likelihood (3-fold increased risk for one allele, 12-fold for two alleles) and often lowering the age of onset.
- ApoE4 is the **most specific and discriminating risk factor** among the options provided.
*Incorrect: Presenilin-2*
- **Presenilin-2** mutations are associated with **early-onset familial Alzheimer's disease**, which typically manifests before age 65 and often has a strong family history.
- This patient is 81 years old and has no significant family history, making early-onset familial AD unlikely.
*Incorrect: ApoE2*
- The **ApoE2 allele** is actually associated with a **decreased risk** of Alzheimer's disease.
- It is thought to be protective due to its more efficient clearance of amyloid beta peptides from the brain.
*Incorrect: Female gender*
- While **female gender** is indeed a risk factor for Alzheimer's disease (women have approximately 2:1 higher lifetime risk even after adjusting for longevity), it is less specific than ApoE4 as a discriminating answer.
- All patients have a biological sex, but only some carry the ApoE4 allele, making ApoE4 a more useful clinical and epidemiological marker.
*Incorrect: Advanced age (>85 years)*
- **Advanced age** is actually the strongest non-modifiable risk factor for Alzheimer's disease, with incidence doubling every 5 years after age 65.
- However, in the context of this question, **ApoE4 is the better answer** because it represents a specific genetic risk factor that can be tested and is directly associated with disease pathogenesis, whereas advanced age is a universal demographic factor that applies to all individuals who live long enough.
Parkinson's disease pathology US Medical PG Question 7: A 59-year-old woman comes to the physician because of progressively worsening coordination and involuntary movements in her left hand for the past 6 months. Her husband also reports that she has been withdrawn and apathetic during this period. She is oriented to time, place, and person. Examination shows a bimanual, rhythmic, low-frequency tremor that is more prominent in the left hand. There is normal range of motion in the arms and legs; active movements are very slow. Muscle strength is normal, and there is increased resistance to passive flexion and extension in the limbs. She walks with a shuffling gait and takes small steps. Which of the following is the most likely underlying cause of this patient's symptoms?
- A. Proliferation of beta-adrenergic receptors from excessive circulating T4
- B. Neuronal degeneration due to α-synuclein protein misfolding (Correct Answer)
- C. Accumulation of neurotoxic metabolites secondary to hepatocyte damage
- D. Copper accumulation due to mutations in hepatocyte copper-transporting ATPase
- E. Cerebellar ischemia due to chronic hypertension
Parkinson's disease pathology Explanation: ***Neuronal degeneration due to α-synuclein protein misfolding***
- This describes **Parkinson's disease (PD)**, characterized by the degeneration of dopaminergic neurons in the **substantia nigra** due to the accumulation of misfolded **α-synuclein** into Lewy bodies.
- The patient's symptoms—**bradykinesia (slow movements), resting tremor (rhythmic, low-frequency tremor), rigidity (increased resistance to passive movement), and shuffling gait**—are classic signs of PD. Apathy and withdrawal are common non-motor symptoms.
*Proliferation of beta-adrenergic receptors from excessive circulating T4*
- This describes symptoms of **hyperthyroidism**, which can cause a fine tremor, but not the **low-frequency resting tremor** and **rigidity** seen in this patient.
- Hyperthyroidism is also associated with weight loss, heat intolerance, and tachycardia, which are not mentioned.
*Accumulation of neurotoxic metabolites secondary to hepatocyte damage*
- This is characteristic of **hepatic encephalopathy**, which presents with altered mental status, asterixis (flapping tremor), and generalized slowness.
- However, the patient's specific motor symptoms like **rigidity, shuffling gait**, and a distinct **resting tremor** are not typical features of hepatic encephalopathy.
*Copper accumulation due to mutations in hepatocyte copper-transporting ATPase*
- This describes **Wilson's disease**, an inherited disorder of copper metabolism. It can cause neurological symptoms, including tremor, dystonia, and ataxia, along with liver disease.
- However, the patient's age (59 years) and the specific presentation of a **resting tremor, bradykinesia, and rigidity** are more consistent with Parkinson's disease than Wilson's, which typically presents in younger individuals.
*Cerebellar ischemia due to chronic hypertension*
- **Cerebellar ischemia** would lead to **ataxia, dysarthria, and intention tremor**, which is a tremor that worsens with voluntary movement, unlike the **resting tremor** observed in this patient.
- **Rigidity and bradykinesia** are not primary symptoms of cerebellar lesions.
Parkinson's disease pathology US Medical PG Question 8: A 28-year-old woman comes to the physician because of a 1-year history of intermittent buzzing in both her ears. She says she sometimes has episodes of mild dizziness which resolve spontaneously. She has a 15-year history of type 1 diabetes mellitus and episodes of low back pain. She does not smoke or drink alcohol. Current medications include insulin and aspirin. She works as a trombonist for a symphony orchestra. Her vital signs are within normal limits. On otoscopic examination, the tympanic membrane appears normal. Bone conduction is greater than air conduction in both ears. Weber test shows no lateralization. Which of the following is the most likely diagnosis?
- A. Presbycusis
- B. Diabetic otopathy
- C. Drug-induced ototoxicity
- D. Otosclerosis (Correct Answer)
- E. Endolymphatic hydrops
Parkinson's disease pathology Explanation: ***Otosclerosis***
- The combination of **conductive hearing loss** (**bone conduction > air conduction**), **intermittent buzzing (tinnitus)**, and mild dizziness in a young adult is characteristic of otosclerosis. The normal tympanic membrane further supports this diagnosis as it indicates no external or middle ear infection/perforation.
- **Weber test shows no lateralization** because the conductive hearing loss is **symmetric and bilateral**, meaning both ears are equally affected.
*Presbycusis*
- This is an age-related **sensorineural hearing loss** that typically affects older individuals, usually over 50-60 years old, not a 28-year-old.
- Presbycusis usually presents with **air conduction > bone conduction** (sensorineural pattern) and affects high frequencies first, not conductive hearing loss.
*Diabetic otopathy*
- While patients with long-standing diabetes can develop hearing loss, it is typically a **sensorineural hearing loss** due to microvascular damage, not conductive hearing loss.
- The symptoms in diabetic otopathy usually involve high-frequency hearing loss and are not typically associated with bone conduction exceeding air conduction.
*Drug-induced ototoxicity*
- **Aspirin** can cause tinnitus and sensorineural hearing loss, but the presented case demonstrates **conductive hearing loss** (bone conduction > air conduction).
- Aspirin ototoxicity typically causes reversible sensorineural hearing loss and tinnitus, not the conductive pattern seen here.
*Endolymphatic hydrops*
- Also known as **Meniere's disease**, this condition causes episodic **vertigo, tinnitus, and sensorineural hearing loss**.
- The hearing loss is typically **sensorineural** and often fluctuating, while this patient presents with signs of **conductive hearing loss**.
Parkinson's disease pathology US Medical PG Question 9: A 56-year-old woman presents to the emergency department with several episodes in which she felt "dizzy." She has had these symptoms on and off for the past year and can recall no clear exacerbating factor or time of day when her symptoms occur. She has a perpetual sensation of fullness in her ear but otherwise has no symptoms currently. Her temperature is 97.6°F (36.4°C), blood pressure is 122/77 mmHg, pulse is 85/min, respirations are 13/min, and oxygen saturation is 98% on room air. Cardiopulmonary exam is unremarkable. The patient's gait is stable. Which of the following is also likely to be found in this patient?
- A. Gradually improving symptoms
- B. Conductive hearing loss
- C. Positional vertigo
- D. Sensorineural hearing loss (Correct Answer)
- E. Vertical nystagmus
Parkinson's disease pathology Explanation: ***Sensorineural hearing loss***
- The sensation of **aural fullness**, recurrent dizzy spells without clear triggers, and the episodic nature of symptoms are classic for **Ménière's disease**.
- **Ménière's disease** is characterized by the triad of **vertigo**, **tinnitus**, and **sensorineural hearing loss**, often accompanied by ear fullness.
*Gradually improving symptoms*
- **Ménière's disease** is a chronic, progressive condition, and symptoms typically **fluctuate** in severity and can worsen over time, rather than gradually improving.
- While periods of remission can occur, the underlying pathology does make a steady improvement unlikely without intervention.
*Conductive hearing loss*
- **Conductive hearing loss** results from problems with sound transmission to the inner ear, such as **earwax** or **ossicular chain dysfunction**.
- **Ménière's disease** specifically affects the inner ear (cochlea and vestibular system), leading to **sensorineural hearing loss** due to endolymphatic hydrops.
*Positional vertigo*
- **Positional vertigo** suggests conditions like **Benign Paroxysmal Positional Vertigo (BPPV)**, where vertigo is triggered by specific head movements due to otolith displacement.
- In this patient, the vertigo is described as recurrent and "on and off" without "clear exacerbating factor," which is less consistent with positional vertigo.
*Vertical nystagmus*
- **Vertical nystagmus** is typically indicative of **central vestibular lesions** or brainstem dysfunction.
- The symptoms presented, including aural fullness and episodic dizziness, point towards a **peripheral vestibular disorder** like Ménière's disease, which usually causes horizontal or rotatory nystagmus during acute attacks.
Parkinson's disease pathology US Medical PG Question 10: A 72-year-old man is brought to your office by his daughter due to concern over recent behavioral changes. Over the last several months he has had increasing difficulty with remembering recent events. She mentions that he is embarrassed due to a new inability to control urination. His medical history is significant for hypertension and insomnia. His medications include alprazolam and hydrochlorothiazide. On physical exam, he is oriented to time and place and thinks his daughter is exaggerating; however, when asked to recall 3 items, the patient refuses to continue the mental status exam. He has 5/5 strength bilaterally. He walks in short strides by sliding his feet across the floor. Which of the following would you expect to see in this patient?
- A. Depigmentation of the substantia nigra pars compacta
- B. Convex hemorrhage that does not cross suture lines
- C. Atrophy of the caudate and putamen
- D. Distortion of corona radiata fibers (Correct Answer)
- E. Atrophy of the subthalamic nucleus
Parkinson's disease pathology Explanation: ***Distortion of corona radiata fibers***
- The patient's symptoms of **memory decline**, **urinary incontinence**, and **gait disturbance** (magnetic gait) form the classic triad of **normal pressure hydrocephalus (NPH)**.
- In NPH, the enlarged ventricles cause **stretching and distortion of the periventricular white matter tracts**, including the ascending and descending fibers of the **corona radiata**, which leads to the characteristic neurological symptoms.
*Depigmentation of the substantia nigra pars compacta*
- This is a hallmark pathological finding in **Parkinson's disease**, characterized by the loss of **dopaminergic neurons** in the substantia nigra.
- While gait disturbance (shuffling gait) can occur in Parkinson's, the presenting symptoms of **urinary incontinence** and prominent memory decline are not typical primary features, and the gait description is more suggestive of NPH.
*Convex hemorrhage that does not cross suture lines*
- This describes an **epidural hematoma**, typically resulting from **head trauma** and often associated with rupture of the **middle meningeal artery**.
- The clinical presentation is usually acute with signs of increased intracranial pressure, rather than the chronic, progressive symptoms described in the patient.
*Atrophy of the caudate and putamen*
- This is a characteristic finding in **Huntington's disease**, a neurodegenerative disorder.
- Huntington's typically presents with **chorea** (involuntary movements), psychiatric disturbances, and cognitive decline, which do not align with the patient's primary symptoms of gait disturbance and incontinence.
*Atrophy of the subthalamic nucleus*
- Atrophy of the subthalamic nucleus is not a distinct primary disorder associated with the patient's constellation of symptoms.
- The subthalamic nucleus plays a role in motor control, and damage to it can cause **hemiballismus**, which is not described here.
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