Case 3—Alice Alice is an i8-year-old girl with a problem: she has been “huffing” for quite a while. After a long history of drug abuse (since the age of 13 she has tried everything from amphetamines to heroin to cocaine to LSD), she found that she much preferred the “high” she received from inhaling the fumes from certain brands of paint. She admits to spending most of her waking hours deeply inhaling from a paint-soaked rag. While she claims she has never “passed out,” she does recall falling asleep at various points during these huffing sessions. Alice walks with a broad ataxic gait, she is unable to complete the standard sobriety tests, and she is slow and uncoordinated. Her hands tremble when she begins to reach for something, but stops when she is in the process of reaching. Her mental status and language seem normal. Her eye movements, however, show abnormalities: her saccades are mildly slowed, and her upgaze slightly restricted. She shows no facial drooping, and there is a lack of overall body rigidity. Her deep tendon reflexes have tested normal, but she is unable to run the heel of her foot up and down her opposite shin. Three months later, after being prevented from huffing at all, her symptoms have improved. Her gait is smoother, and she is able to complete the standard sobriety test, though with some difficulty. Examination of her “favorite” brands of paint reveals that they contain toluene.
Questions
I. What condition or conditions (there may be more than one possibility) are being described in this case? Does this involve brain damage, a specific disease or disorder, or some other condition that may be affecting the patient’s ability to move?
2. What brain area or area(s) may be involved? How should they function normally? What could be causing this dysfunction?
3. How would the treatments recommended affect the brain? How might those effects relate to the symptoms?
4. How can you explain all of the symptoms exhibited by this case? Can you relate each symptom to a specific brain area or neurotransmitter?
5. What other interventions may be possible, besides those noted here? Remember to document your sources.
“Mini Cases in Movement Disorders” by Antoinette R. Miller Page 4
