Masked facies

Cranial nerves Note facial tone and symmetry, gaze preference, and ptosis check for nystagmus by having patient follow object across visual field engage in conversation to assess for slurred speech. Myasthenia gravis (ptosis), Parkinson s disease (masked facies), stroke (palsy), antiepileptic drug therapy (nystagmus, slurred speech)... 

Both patients exhibited severe symptoms associated with manganese exposure (masked facies, marked rigidity, hypokinesia). When manganese supplementation in the TPN was reduced, the blood and brain levels returned to normal. 

Rigidity is the abnormal increase in muscle tone that causes the patient to make postural changes such a shuffling gate, the chest and head is thrust forward, and knees and hips are flexed. The patient walks without swinging his arms. These movements are slow (bradykinesia) and the patient exhibits involuntary tremors of the head and neck which may be more prevalent at rest and pill-rolling movements of the hands. Another characteristic symptoms is the masked facies (no facial expression) common in patients with Parkinson s disease. 

Contents of REE in massive sulfides from the BMC are strongly controlled by the abundance of and REE concentrations in phosphate minerals, specifically apatite, xenotime and monazite. Strong positive Eu anomalies in apatite, account for the anomalous Eu signatures of exhalative sulfides whereas REE in monazite masses are largely reflective of detrital sources and may mask hydrothermal signatures. Limited release of mobile trace elements (LREE and Eu) during green-schist facies metamorphism has partly modified REE profiles for VMS deposits of the BMC. 

Pseudoparkin- sonism Bradykinesia, rigidity, sialorrhea, mask-like facies, resting tremor, pill rolling, shuffling gait -1 week... 

The tremor and rigidity characteristic of parkinsonism are relieved by benztropine mesylate, and it is particularly valuable for those patients who cannot tolerate central excitation (e.g., aged patients). It may also have a useful effect in minimizing drooling, sialorrhea, mask-like facies, oculogyric crises, and muscular cramps. 

Poverty of movement in Parkinsonism most commonly manifests itself in the mask-like facies of subjects and in their failure to swing the arms when walking, while the decrease in the size of handwriting illustrates the reduction in amplitude of movement. In general, movement is impaired without any obvious disturbances of power or coordination, but patients may also suffer brief episodes of complete immobility termed akinetic attacks [9]. 

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