II. Findings: General
- Key features of classic Parkinsonism are prominent
- Ataxia
- Bradykinesia
- Postural Instability
- Resting Tremor
- Rigidity
- Atypical Features vary depending on affected neurologic distribution
- Lewy Body Dementia
- Multiple system atrophy
- Cortical Basal Ganglionic Degeneration (CBGD)
- Progressive supranuclear palsy
- Distinguishing features
- Resting Tremor absent
- Refractory to Carbidopa/Levodopa
III. Signs: Prominent Features
- Cerebellar signs (dysmetria, Ataxia) with impaired gait
- Myoclonus
- Cognitive deficits (including early-onset Dementia)
- Hallucinations
- Impaired speech
- Urinary Incontinence
- Early symptomatic Postural Hypotension (Dysautonomia)
- Cortical Basal Ganglionic Degeneration
- Alien limb phenomenon (involuntary extremity motor activity while feeling the limb is detached)
-
Upper Motor Neuron signs
- Axial rigidity is greater than extremity rigidity
- Pyramidal tract signs (hyperreflexia, weakness, spasticity, positive Babinski Sign)
- Progressive Supranuclear palsy (Supranuclear Gaze Palsy)
- Olfaction is normal
- Vertical Gaze Paralysis and postural instability
- Difficulty reading
- Loss of Down gaze
IV. Course
- Early-onset Dementia
- Rapidly progressive course
V. References
- Ahlskog (2011) Mayo Internal Medicine Review Lecture
- Schim (2001) CMEA Medicine Lecture, San Diego
- Clarke (2003) Clin Evid 10:1582-98 [PubMed]
- Clarke (2004) Lancet Neurol 3:466-74 [PubMed]
- Gazewood (2013) Am Fam Physician 87(4): 267-73 [PubMed]
- Nutt (2005) N Engl J Med 353:1021-7 [PubMed]
- Olanow (2001) Neurology 56:S1-88 [PubMed]
- Rao (2006) Am Fam Physician 74:2046-56 [PubMed]
- Young (1999) Am Fam Physician 59(8):2155-67 [PubMed]