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  • Print publication year: 2005
  • Online publication date: August 2010

37 - Approach to the patient presenting with parkinsonism

from Part VII - Parkinson's and related movement disorders


General symptomatology of patients with parkinsonism

In the nearly 200 years since James Parkinson's original essay on ‘shaking palsy’ (Parkinson, 1817), clinicians have learned that he described a syndrome rather than a specific disease and that Parkinson's has many imitators. As a syndrome, parkinsonism is characterized by tremor, bradykinesia, rigidity and postural reflex compromise. Parkinson's disease is one of many parkinsonian syndromes and is defined by the same clinical signs in association with a distinct type and pattern of cellular degeneration. Parkinsonism can occur as an isolated clinical syndrome, classified as primary when it is due to hereditary or idiopathic causes or secondary when it has another identifiable underlying etiology. When parkinsonism occurs in association with other neurological signs, it is classified as one of the well-defined parkinsonism-plus syndromes or as parkinsonism associated with defined hereditodegenerative disorders (Table 37.1). Parkinson's disease is the archetype of primary parkinsonism. A thorough history and comprehensive examination can usually differentiate Parkinson's disease from other parkinsonian syndromes. Nevertheless, clinicopathological studies have shown that 20% of patients thought clinically to have Parkinson's disease turn out to have pathological cellular changes suggestive of other diagnoses, and 5–10% of parkinsonian subjects with an atypical clinical picture for Parkinson's disease have the typical cellular changes of Parkinson's disease at autopsy (Hughes et al., 2001).

Unilateral tremor is the most common initial symptom resulting in medical consultation for Parkinson's disease.

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