International referral and elderly care - A case of atypical parkinsonism and cerebellar atrophy

A 66-year-old male patient had a history of hepatitis B, was a hepatitis C carrier, and had hypertension. He was referred to our family medicine international clinic by the Canadian Physician's Referral Service. He had had progressive general weakness over 2 years, and the symptom had recently exacerbated. He also had slurred speech, difficulty in swallowing with occasional choking, constipation, and urinary incontinence. He was diagnosed as having Parkinson disease, but his symptoms worsened despite treatment with levodopa 250 mg four times daily for 2 years. He had sought medical help in many clinics in Taiwan and Canada and was referred to our outpatient clinic by his Canadian family physician. The neurologist suggested that the diagnosis was multiple system atrophy (MSA) after history taking and neurologic examination. Rehabilitation programs, including physical therapy, occupational therapy and speech therapy, were arranged for him. Many Taiwanese immigrants prefer to come back to Taiwan for medical treatment. If we can integrate medical resources not only between different hospitals but also between different countries, many unnecessary medical expenses could be avoided. In this case, we summarized the case history and provided him with a CD of the images. This will be helpful in further care by a Canadian physician.