A 65-year-old right-handed man found his written characters shrinking in size when testing a ballpoint pen at a stationery store over a 2-year period. He showed normal ocular movement, bilateral resting tremor, rigidity and bradykinesia without aphasia and ataxia. When he wrote a sentence in Japanese and figures, the size of the characters remained unchanged; however, when he attempted to reproduce the trial writing, his vertical cursive “L” shrank, corresponding to progressive micrographia (PM) (Picture 1). Brain magnetic resonance imaging showed no abnormal intensity or atrophy (Picture 2A, B), but 123I-metaiodobenzylguanidine cardiac scintigraphy demonstrated a reduction in the cardiac uptake (heart/mediastinum ratio, early/delayed: 1.64/1.27; Picture 2C). After noting improvement in his bradykinesia and the persistence of the PM symptoms with levodopa, we diagnosed him with Parkinson disease (PD). Writing a vertical cursive “L” might be useful for confirming PM and a simple way to detect micrographia, which is considered a motor prodrome of PD (1).
Picture 1.
Picture 2.
Written informed consent was obtained from the patient.
The authors state that they have no Conflict of Interest (COI).
References
- 1. Simonet C, Schrag A, Lees AJ, Noyce AJ. The motor prodromes of Parkinson's disease: from bedside observation to large-scale application. J Neurol 268: 2099-2108, 2021. [DOI] [PMC free article] [PubMed] [Google Scholar]