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Symptoms and Signs – Differential Diagnosis of Parkinson’s Disease
• Toxins (e.g., 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine [MPTP], manganese, carbon monoxide)
• Secondary (acquired) parkinsonism
• Progressive supranuclear palsy: tends to have axial rigidity greater than appendicular (limb) rigidity. These patients have early and severe postural instability. Hallmark is supranuclear gaze palsy that usually involves vertical gaze before horizontal.
• Postinfectious parkinsonism: von Economo’s encephalitis
• Parkinson’s pugilistica: after repeated head trauma
• Multisystem atrophy: distinguishing features of autonomic dysfunction, including urinary incontinence, orthostatic hypotension, and erectile dysfunction; parkinsonism, cerebellar signs, and normal cognition
• Iatrogenic: any of the neuroleptics and antipsychotics. The high potency D2 blocker neuroleptics are most likely to cause parkinsonism.
• Essential tremor
• Diffuse Lewy body disease: parkinsonism with concomitant dementia. Patients often have early hallucinations and fluctuations in level of alertness and mental status.
• Corticobasal degeneration: often begins asymmetrically with apraxia, cortical sensory loss in one limb, and sometimes alien limb phenomenon
• Cerebrovascular disease (basal ganglia infarcts)
• Toxins (e.g., 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine [MPTP], manganese, carbon monoxide)
• Secondary (acquired) parkinsonism
• Progressive supranuclear palsy: tends to have axial rigidity greater than appendicular (limb) rigidity. These patients have early and severe postural instability. Hallmark is supranuclear gaze palsy that usually involves vertical gaze before horizontal.
• Postinfectious parkinsonism: von Economo’s encephalitis
• Parkinson’s pugilistica: after repeated head trauma
• Multisystem atrophy: distinguishing features of autonomic dysfunction, including urinary incontinence, orthostatic hypotension, and erectile dysfunction; parkinsonism, cerebellar signs, and normal cognition
• Iatrogenic: any of the neuroleptics and antipsychotics. The high potency D2 blocker neuroleptics are most likely to cause parkinsonism.
• Essential tremor
• Diffuse Lewy body disease: parkinsonism with concomitant dementia. Patients often have early hallucinations and fluctuations in level of alertness and mental status.
• Corticobasal degeneration: often begins asymmetrically with apraxia, cortical sensory loss in one limb, and sometimes alien limb phenomenon
• Cerebrovascular disease (basal ganglia infarcts)
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