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Parkinsonism
DIFFERENTIAL DIAGNOSIS OF PARKINSON'S DISEASE
Parkinson's disease is an idiopathic, relentlessly progressive,
neurologic disorder manifested clinically by tremor, bradykinesia,
rigidity, and postural instability. In addition to these four cardinal
signs, there are many motor and nonmotor manifestations of Parkinson's
disease, including cognitive, sensory, and autonomic disturbances.
Within Parkinson's disease, there are different subgroups with
relatively specific clinical patterns.
Secondary parkinsonism is thought to represent 8.2% of all our
parkinsonian patients. The causes include environmental exposure
(e.g., drugs or toxins) and other factors(trauma, metabolic
derangement, infection, stroke, brain tumor). 'Lower body'
parkinsonism, a condition in which upper body motor function is
relatively preserved while gait is markedly impaired, is often
associated with multiple lacunar infarctions and may represent one
form of vascular parkinsonism. (Fitzgerald PM, Jankovic J: Lower body parkinsonism: Evidence for
vascular etiology. Mov Disorders 4:249, 1989)
The symptoms that are reviewed in making a differential diagnosis among the various types of Parkinsonism are:
Bradykinesia
Rigidity
Gait disturbance
Tremor
Ataxta
Dysautonomia
Dementia
Dysarthria/
dysphagia
Dystonia
Eyelid apraxia
Limb apraxia
Motor neuron
disease
Myoclonus
Neuropathy
Oculomotility
disturbance
Orthostatic
hypotension
Sleep abnormal
Asymmetric find
Levodopa response
The various types of Parkinsonism's include:
Primary (idiopathic) parkinsonism
Parkinson's disease
Juvenile parkinsonism
Secondary (acquired,symptomatic) parkinsonism
infectious: postencephalitic, slow virus
Drugs:dopamine receptor blocking drugs (antipsychotic. antiemetic drugs),
reserpine, tetrabenazine, alpha-methyl-dopa, lithium. flunarizine,
cinnarizine
Toxins:MPTP, CO, Mn, Hg. CS2, methanol, ethanol
Vascular:multi-infarct
Trauma:pugilistic encephalopathy
Other:parathyroid abnormalities, hypothyroidism. hepatocerebral degeneration.
brain tumor, normal pressure hydrocephalus. syringomesencephatia
Heredodegenerative parkinsonism
Huntington's disease
Wilson's disease
Hallervorden-Spatz disease
Olivopontocerebellar and spinocerebellar degenerations
Familial basal ganglia calcification
Familial parkinsonism with peripheral neuropathy
Neuroacanthocytosis
Multiple system degenerations (parkinsonism plus)
Progressive supranuclear palsy
Shy-Drager syndrome
Striatonigral degeneration
Parkinsonism-dementia-ALS complex
Corticobasat ganglionic degeneration
Autosomal dominant Lewy body disease
Alzheimer's disease
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