21st June 2023

A 72-year-old man with Parkinson’s Disease comes into A&E after going out to an anniversary meal

A 72-year-old man with Parkinson’s Disease comes into A&E after going out to an anniversary meal with his wife earlier that evening. He complains of a severe headache in the back of his head, dizziness, sweating, palpitations, tingling in his feet and photosensitivity.

On examination:

Flushed

HR 140 bpm

BP 210/108 mmHg

Neurology – sensitivity to the pupillary light reflex and numbness in the hands and feet. No other focal neurology.

Which Parkinson’s medication is the most likely cause of this presentation?