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. 1988 May;64(751):345–351. doi: 10.1136/pgmj.64.751.345

Accuracy in the clinical diagnosis of parkinsonian syndromes.

W R Gibb 1
PMCID: PMC2428656  PMID: 3059338

Abstract

This review of Parkinson's disease and related disorders emphasizes the difficulties of distinguishing between variants of the parkinsonian syndrome. Characteristic clinical features may remain absent for many months, but accuracy of diagnosis may be improved by considering certain presenting symptoms and signs. The main characteristics of various parkinsonian syndromes are reviewed and their major distinguishing features are emphasized. Future improvement in the precision of clinical diagnosis, especially early in the course of parkinsonian syndromes, will depend on selecting out patients with Parkinson's disease using positive diagnostic criteria.

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Selected References

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  1. Andrews J. M., Terry R. D., Spataro J. Striatonigral degeneration. Clinical-pathological correlations and response to stereotaxic surgery. Arch Neurol. 1970 Oct;23(4):319–329. doi: 10.1001/archneur.1970.00480280033004. [DOI] [PubMed] [Google Scholar]
  2. BICKERSTAFF E. R., CLOAKE P. C. P. Mesencephalitis and rhombencephalitis. Br Med J. 1951 Jul 14;2(4723):77–81. doi: 10.1136/bmj.2.4723.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ballard P. A., Tetrud J. W., Langston J. W. Permanent human parkinsonism due to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP): seven cases. Neurology. 1985 Jul;35(7):949–956. doi: 10.1212/wnl.35.7.949. [DOI] [PubMed] [Google Scholar]
  4. Berger J. R., Ross D. B. Reversible Parkinson syndrome complicating postoperative hypoparathyroidism. Neurology. 1981 Jul;31(7):881–882. doi: 10.1212/wnl.31.7.881. [DOI] [PubMed] [Google Scholar]
  5. Bernheimer H., Birkmayer W., Hornykiewicz O., Jellinger K., Seitelberger F. Brain dopamine and the syndromes of Parkinson and Huntington. Clinical, morphological and neurochemical correlations. J Neurol Sci. 1973 Dec;20(4):415–455. doi: 10.1016/0022-510x(73)90175-5. [DOI] [PubMed] [Google Scholar]
  6. Clough C. G., Plaitakis A., Yahr M. D. Oculogyric crises and parkinsonism. A case of recent onset. Arch Neurol. 1983 Jan;40(1):36–37. doi: 10.1001/archneur.1983.04050010056014. [DOI] [PubMed] [Google Scholar]
  7. Corsellis J. A., Bruton C. J., Freeman-Browne D. The aftermath of boxing. Psychol Med. 1973 Aug;3(3):270–303. doi: 10.1017/s0033291700049588. [DOI] [PubMed] [Google Scholar]
  8. DUVOISIN R. C., YAHR M. D. ENCEPHALITIS AND PARKINSONISM. Arch Neurol. 1965 Mar;12:227–239. doi: 10.1001/archneur.1965.00460270003001. [DOI] [PubMed] [Google Scholar]
  9. David N. J., Mackey E. A., Smith J. L. Further observations in progressive supranuclear palsy. Neurology. 1968 Apr;18(4):349–356. doi: 10.1212/wnl.18.4.349. [DOI] [PubMed] [Google Scholar]
  10. Davis G. C., Williams A. C., Markey S. P., Ebert M. H., Caine E. D., Reichert C. M., Kopin I. J. Chronic Parkinsonism secondary to intravenous injection of meperidine analogues. Psychiatry Res. 1979 Dec;1(3):249–254. doi: 10.1016/0165-1781(79)90006-4. [DOI] [PubMed] [Google Scholar]
  11. Davis P. H., Bergeron C., McLachlan D. R. Atypical presentation of progressive supranuclear palsy. Ann Neurol. 1985 Apr;17(4):337–343. doi: 10.1002/ana.410170406. [DOI] [PubMed] [Google Scholar]
  12. Dubas F., Gray F., Escourolle R. Maladie de Steele-Richardson-Olszewski sans ophtalmoplégie. Six cas anatomo-cliniques. Rev Neurol (Paris) 1983;139(6-7):407–416. [PubMed] [Google Scholar]
  13. ESPIR M. L., SPALDING J. M. Three recent cases of encephalitis lethargica. Br Med J. 1956 May 19;1(4976):1141–1144. doi: 10.1136/bmj.1.4976.1141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Feve J. R., Mussini J. M., Mathé J. F., Cler J. M., Nomballais M. F. Dégénérescence striato-nigrique. Etude clinique et anatomique d'un cas ayant réagi très favorablement à la L-Dopa. Rev Neurol (Paris) 1977 Apr;133(4):271–278. [PubMed] [Google Scholar]
  15. Gibb W. R., Lees A. J. The progression of idiopathic Parkinson's disease is not explained by age-related changes. Clinical and pathological comparisons with post-encephalitic parkinsonian syndrome. Acta Neuropathol. 1987;73(2):195–201. doi: 10.1007/BF00693789. [DOI] [PubMed] [Google Scholar]
  16. Hoehn M. M., Yahr M. D. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427–442. doi: 10.1212/wnl.17.5.427. [DOI] [PubMed] [Google Scholar]
  17. Howard R. S., Lees A. J. Encephalitis lethargica. A report of four recent cases. Brain. 1987 Feb;110(Pt 1):19–33. doi: 10.1093/brain/110.1.19. [DOI] [PubMed] [Google Scholar]
  18. Jellinger K., Riederer P. Dementia in Parkinson's disease and (pre) senile dementia of Alzheimer type: morphological aspects and changes in the intracerebral MAO activity. Adv Neurol. 1984;40:199–210. [PubMed] [Google Scholar]
  19. Jellinger K., Riederer P., Tomonaga M. Progressive supranuclear palsy: clinico-pathological and biochemical studies. J Neural Transm Suppl. 1980;(16):111–128. doi: 10.1007/978-3-7091-8582-7_12. [DOI] [PubMed] [Google Scholar]
  20. Kessler I. I. Epidemiologic studies of Parkinson's disease. II. A hospital-based survey. Am J Epidemiol. 1972 Apr;95(4):308–318. doi: 10.1093/oxfordjournals.aje.a121399. [DOI] [PubMed] [Google Scholar]
  21. Klawans H. L., Jr, Zeitlin E. L-dopa in Parkinsonism associated with cerebellar dysfunction (probable olivopontocerebellar degeneration). J Neurol Neurosurg Psychiatry. 1971 Feb;34(1):14–19. doi: 10.1136/jnnp.34.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Klawans H. L., Stein R. W., Tanner C. M., Goetz C. G. A pure parkinsonian syndrome following acute carbon monoxide intoxication. Arch Neurol. 1982 May;39(5):302–304. doi: 10.1001/archneur.1982.00510170044012. [DOI] [PubMed] [Google Scholar]
  23. Koller W. C., Cochran J. W., Klawans H. L. Calcification of the basal ganglia: computerized tomography and clinical correlation. Neurology. 1979 Mar;29(3):328–333. doi: 10.1212/wnl.29.3.328. [DOI] [PubMed] [Google Scholar]
  24. LEIGH A. D. Infections of the nervous system occurring during an epidemic of influenza B. Br Med J. 1946 Dec 21;2(4485):936–938. doi: 10.1136/bmj.2.4485.936. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lang A. E., Birnbaum A., Blair R. D., Kierans C. Levodopa dose-related fluctuations in presumed olivopontocerebellar atrophy. Mov Disord. 1986;1(2):93–102. doi: 10.1002/mds.870010203. [DOI] [PubMed] [Google Scholar]
  26. Langston J. W., Ballard P., Tetrud J. W., Irwin I. Chronic Parkinsonism in humans due to a product of meperidine-analog synthesis. Science. 1983 Feb 25;219(4587):979–980. doi: 10.1126/science.6823561. [DOI] [PubMed] [Google Scholar]
  27. Lee J. E., Sweet R. D., McDowell F. H. Treatment of parkinsonism with levodopa. Follow-up after 2 years of treatment. Ann Intern Med. 1971 Nov;75(5):703–708. doi: 10.7326/0003-4819-75-5-703. [DOI] [PubMed] [Google Scholar]
  28. Maher E. R., Lees A. J. The clinical features and natural history of the Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Neurology. 1986 Jul;36(7):1005–1008. doi: 10.1212/wnl.36.7.1005. [DOI] [PubMed] [Google Scholar]
  29. Marsden C. D., Parkes J. D. Success and problems of long-term levodopa therapy in Parkinson's disease. Lancet. 1977 Feb 12;1(8007):345–349. doi: 10.1016/s0140-6736(77)91146-1. [DOI] [PubMed] [Google Scholar]
  30. Marsden C. D., Schachter M. Assessment of extrapyramidal disorders. Br J Clin Pharmacol. 1981 Feb;11(2):129–151. doi: 10.1111/j.1365-2125.1981.tb01118.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Mölsä P. K., Marttila R. J., Rinne U. K. Extrapyramidal signs in Alzheimer's disease. Neurology. 1984 Aug;34(8):1114–1116. doi: 10.1212/wnl.34.8.1114. [DOI] [PubMed] [Google Scholar]
  32. Nygaard T. G., Duvoisin R. C. Hereditary dystonia-parkinsonism syndrome of juvenile onset. Neurology. 1986 Nov;36(11):1424–1428. doi: 10.1212/wnl.36.11.1424. [DOI] [PubMed] [Google Scholar]
  33. Pearce J. The extrapyramidal disorder of Alzheimer's disease. Eur Neurol. 1974;12(2):94–103. doi: 10.1159/000114608. [DOI] [PubMed] [Google Scholar]
  34. Perkin G. D., Lees A. J., Stern G. M., Kocen R. S. Problems in the diagnosis of progressive supranuclear palsy. (Steele--Richardson--Olszewski syndrome). Can J Neurol Sci. 1978 May;5(2):168–173. [PubMed] [Google Scholar]
  35. Pfaffenbach D. D., Layton D. D., Jr, Kearns T. P. Ocular manifestations in progressive supranuclear palsy. Am J Ophthalmol. 1972 Dec;74(6):1179–1184. doi: 10.1016/0002-9394(72)90740-4. [DOI] [PubMed] [Google Scholar]
  36. Rail D., Scholtz C., Swash M. Post-encephalitic Parkinsonism: current experience. J Neurol Neurosurg Psychiatry. 1981 Aug;44(8):670–676. doi: 10.1136/jnnp.44.8.670. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Rebeiz J. J., Kolodny E. H., Richardson E. P., Jr Corticodentatonigral degeneration with neuronal achromasia. Arch Neurol. 1968 Jan;18(1):20–33. doi: 10.1001/archneur.1968.00470310034003. [DOI] [PubMed] [Google Scholar]
  38. Ringel S. P., Klawans H. L., Jr Carbon monoxide-induced Parkinsonism. J Neurol Sci. 1972 Jul;16(3):245–251. doi: 10.1016/0022-510x(72)90190-6. [DOI] [PubMed] [Google Scholar]
  39. Scott R. M., Brody J. A., Schwab R. S., Cooper I. S. Progression of unilateral tremor and rigidity in Parkinson's disease. Neurology. 1970 Jul;20(7):710–714. doi: 10.1212/wnl.20.7.710. [DOI] [PubMed] [Google Scholar]
  40. Snider S. R., Fahn S., Isgreen W. P., Cote L. J. Primary sensory symptoms in parkinsonism. Neurology. 1976 May;26(5):423–429. doi: 10.1212/wnl.26.5.423. [DOI] [PubMed] [Google Scholar]
  41. Stephen P. J., Williamson J. Drug-induced parkinsonism in the elderly. Lancet. 1984 Nov 10;2(8411):1082–1083. doi: 10.1016/s0140-6736(84)91516-2. [DOI] [PubMed] [Google Scholar]
  42. Sulkava R. Alzheimer's disease and senile dementia of Alzheimer type. A comparative study. Acta Neurol Scand. 1982 Jun;65(6):636–650. doi: 10.1111/j.1600-0404.1982.tb03117.x. [DOI] [PubMed] [Google Scholar]
  43. Sypert G. W., Leffman H., Ojemann G. A. Occult normal pressure hydrocephalus manifested by parkinsonism-dementia complex. Neurology. 1973 Mar;23(3):234–238. doi: 10.1212/wnl.23.3.234. [DOI] [PubMed] [Google Scholar]
  44. Tolosa E. S., Santamaría J. Parkinsonism and basal ganglia infarcts. Neurology. 1984 Nov;34(11):1516–1518. doi: 10.1212/wnl.34.11.1516. [DOI] [PubMed] [Google Scholar]
  45. Williams A., Houff S., Lees A., Calne D. B. Oligoclonal banding in the cerebrospinal fluid of patients with postencephalitic Parkinsonism. J Neurol Neurosurg Psychiatry. 1979 Sep;42(9):790–792. doi: 10.1136/jnnp.42.9.790. [DOI] [PMC free article] [PubMed] [Google Scholar]

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