Education And Debate

Fortnightly Review: Parkinsonism—recognition and differential diagnosis

BMJ 1995; 310 doi: (Published 18 February 1995) Cite this as: BMJ 1995;310:447
  1. Niall Quinn, reader in clinical neurologya
  1. a Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG


    Summary points

    • The cumulative lifetime risk of a person developing parkinsonism has been estimated at 1 in 40

    • Idiopathic Parkinson's disease is the commonest cause, but about a third of patients with the syndrome of parkinsonism or a diagnosis of Parkinson's disease have some other disease instead

    • The diagnosis of Parkinson's disease is entirely clinical, but the results of certain investigations may help in recognising alternative causes for parkinsonism

    • For a diagnosis of established parkinsonism, upper body akinesia must be present; rigidity is usually, but not always, present; tremor is an optional extra

    • The two conditions that are most commonly misdiagnosed as Parkinson's disease—essential tremor and arteriosclerotic pseudoparkinsonism—do not display true parkinsonism

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