Distinguishing clinical features of the neurodegenerative and non-neurodegenerative causes of parkinsonism
| Clinical Features of Parkinsonism (Bradykinesia, Rigidity, Tremor) | Additional Helpful Clinical Features | |
|---|---|---|
| Neurodegenerative Parkinsonism | ||
| Parkinson disease | Yes | Nil |
| Multiple system atrophy | Yes | Pyramidal, autonomic, and cerebellar signs |
| Progressive supranuclear palsy | Yes | Supranuclear gaze palsy, increased axial tone, bulbar palsy, early postural instability |
| Corticobasal degeneration | Yes | Asymmetric cortical dysfunction |
| Dementia with Lewy bodies | Yes | Fluctuating dementia, visual hallucinations, hypersensitivity to neuroleptic medications |
| Non-neurodegenerative etiologies of parkinsonism | ||
| Essential tremor | Tremor | Usually bilateral tremor that worsens on movement; tremor can affect head and voice |
| Vascular parkinsonism | Bradykinesia with at least one of resting tremor, rigidity, or postural instability | Cerebrovascular disease diagnosed clinically or on CT/MR imaging; temporal relationship between cerebrovascular infarcts near or within the basal ganglia and acute/progressive development of parkinsonism; insidious onset of parkinsonism with bilateral symptoms at onset, presence of early shuffling gait, or cognitive dysfunction and extensive subcortical white matter lesions on MRI |
| Drug-induced parkinsonism | Yes | Very difficult to distinguish clinically from neurodegenerative idiopathic Parkinson disease |