Parkinsonism - Parkinson's Plus Syndromes
Parkinsonism → Syndrome that looks like Parkinson’s disease
Cause of Parkinsonism:
- Drug-Induced → (Antipsychotics: Haloperidol, Risperidone)
- Vascular → (Multi-infarct, Binswanger’s)
- Toxins → (MPTP, CO, Mn, Cyanide)
- Postencephalitic → (Increase Encephalitis, lethargica)
- Trauma → (Head injury, repeated)
- Normal Presssure Hydrocephalus (NPH)
Parkinson-Plus Syndromes → Parkinsonism plus additional neurological signs.
Common Points in Parkinson-Plus:
- Rapid Progression → Wheelchair early
- Severe Autonomic Dysfunction
- Early Postural Instability & falls
- No / Minimal Levodopa response
- Poor Prognosis
Different from Parkinson’s disease
- Acute/subacute onset
- Symmetrical (both sides)
- Early falls (common)
- No Non-motor features
- Poor Levodopa response
Parkinson-Plus Syndrome:
Progressive Supranuclear Palsy
Key Features:
- Vertical Gaze Palsy
- Early Falls
- Axial Rigidity > Limb
- “Look up and fall down”
- No response to Levadopa
Parkinson-Plus Syndrome:
Corticobasal Degeneration
Key Features:
- Asymmetric Onset
- Limb Apraxia
- Alien Limb Phenomenon
- Cortical Signs
- Poor response to Levodopa
Parkinson-Plus Syndrome:
Multi-System Atrophy
Key Features:
- Antinomic Failure
- Low blood pressure, incontinence
- Cerebellar Ataxia
- Poor Prognosis (2-5 years)
- Poor response to Levodopa