Parkinsonism

Parkinsonism is when there is a triad of bradykinesia, resting tremors and rigidity. There are many causes of parkinsonism. The most commonly seen parkinsonism in the  undergraduate medical final examinations would be Idiopathic Parkinson's disease. 

However, not everyone presenting with Parkinsonism signs have Idiopathic Parkinson's Disease. Therefore students should be wary and mindful about offering the diagnosis of Idiopathic Parkinson's disease upon encountering patients with the above triad. Remember, Idiopathic Parkinson's is a clinical diagnosis and its aetiology is idiopathic i.e. cause is uncertain. Although it is a clinical diagnosis and lab and radiological workup is not required to make the diagnosis, it is also important to consider other differentials causing Parkinsonism signs especially if the patient has risk factors. 

One key feature of Idiopathic Parkinson's Disease is that it is asymmetrical. In the early stages of the disease, parkinsonism can be seen affecting one side of the body. As shown in the video above, this patient has resting tremors affecting his right hand. 

The video below shows bradykinesia affecting the right hand of the same patient. 

As the disease progresses over the years, it may affect the contralateral side of the body as well. However, the key feature remains and Parkinsonism signs would still be asymmetrical. As shown in the next video below, this elderly gentleman has advanced Idiopathic Parkinson's disease as well but take note that the frequency of tremors affecting one arm is different from the other arm. 

Anything that causes damage to the basal ganglia can result in Parkinsonism. For example stroke (vascular), demyelinating diseases, brain tumors, drugs or even metabolic disorders like Wilson's disease. It is good to revise about Parkinsonism as it is a common appearance for the medical examinations. 

CCE.