Parkinsonism Features
Parkinsonism includes features like rigidity, hypomimia, resting tremor, and difficulties with gait. The differential is broad.
Timing of Symptoms
Onset of symptoms:
Hours ago
Days ago
Weeks ago
Months ago
Years ago
Duration of symptoms:
Hours
Days
Weeks
Months
Years
Prior Workup
Prior neurologic evaluation
Prior brain and/or spine imaging
Speech/PT/OT evaluation
Good response to prior dopaminergic therapy
Poor response to prior dopaminergic therapy
Differential Diagnosis
Parkinsons Disease
Tremor: head, voice, chin, or extremities (unilateral or bilateral, rest/action)
Rigidity: stiffness, pain (particularly in shoulder)
Bradykinesia (slowness of movements, slowed reaction time, takes longer to carry out tasks)
Hypokinesia: decreased amplitude of movements (micrographia, small steps)
Akinesia (delayed movement initiation reduced frequency of spontaneous movements)
Postural instability
Hypophonia
Hypomimia
Positional dizziness
Anosmia
Constipation
Dysphagia
Lewy Body Dementia
Cognitive symptoms preceding or simultaneous with parkinsonism
Recurrent well-formed visual hallucinations
Major fluctuations in alertness or cognition
Severe neuroleptic sensitivity
Poor response to dopaminergic therapy
Multi-system Atrophy
Prominent dysautonomia or orthostatic hypotension
Dysarthria
Ataxia
Nystagmus
Laryngeal stridor
Early and severe dysphagia
Anterocollis (head tilted forward)
Rapid progression of symptoms
Poor response to dopaminergic therapy
Progressive Supranuclear Palsy
Early frequent unprovoked falls (typically backwards)
Early dysarthria and dysphagia
Restriction of vertical-horizontal gaze
Retrocollis (head tilted back)
Eyelid apraxia (“wide-eyed look”)
Axial rigidity
Absent or minimal tremor
Poor response to dopaminergic therapy
Corticobasal Degeneration
Gradual loss of one hand or leg with the following features: rigidity, dystonia, myoclonus, alien limb, Ideomotor apraxia
Poor response to dopaminergic therapy
Normal Pressure Hydrocephalus
Wet, wacky, wobbly
Prior history of TBI, meningitis, ICH, brain surgery, brain radiation (secondary NPH)
Drug-induced parkinsonism
Chronic use of dopamine blocking medications
Vascular parkinsonism
Basal ganglia infarcts
Extensive sub-cortical white matter disease
Parkinsonism-Specific Review of Systems
Cognitive difficulties
Alcohol or drug abuse (especially chronic amphetamine abuse)
REM sleep behavior disorder
Ambulation aide(s) needed (type and duration)
Falls (specify frequency and severity)
Family history of dementia or parkinsonian conditions
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