Case history
Case history #1
A 20-year-old previously healthy man has an episode of jaundice associated with tiredness. He is found to have elevated serum aminotransferase enzymes (AST 150 units/L, ALT 175 units/L) and elevated serum bilirubin (4.5 mg/dL [77.0 micromol/L]). Ophthalmologic exam for Kayser-Fleischer rings is negative.
Case history #2
An 18-year-old woman presents with bilateral tremor of the hands. She is a senior in high school and during the year her grades have plummeted to the point that she is failing. She says her memory is now poor, and she has trouble focusing on tasks. Her behavior has changed in the past 6 months in that she has frequent episodes of depression, separated by episodes of bizarre behavior, including shoplifting and excessive drinking. Her parents and other authorities have begun to suspect her of using street drugs, which she denies. Her handwriting has become very sloppy. Her parents have noted slight slurring of her speech. Physical exam reveals upper-extremity tremor, mild dystonia of the upper extremities, and mild incoordination involving her hands. Slit-lamp exam reveals Kayser-Fleischer rings.
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