Zusammenfassung
In order to make a diagnosis of idiopathic Parkinson's disease, it is necessary to rule out the possibility of symptomatic or atypical Parkinsonian syndromes. Atypical Parkinsonian syndromes include multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies and corticobasal degeneration. The most common symptomatic Parkinsonian syndromes are caused by vascular disease or ...
Zusammenfassung
In order to make a diagnosis of idiopathic Parkinson's disease, it is necessary to rule out the possibility of symptomatic or atypical Parkinsonian syndromes. Atypical Parkinsonian syndromes include multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies and corticobasal degeneration. The most common symptomatic Parkinsonian syndromes are caused by vascular disease or induced by neuroleptics. Red flags that point to a diagnosis different from idiopathic Parkinson's disease include missing or unsatisfactory response to L-dopa and additional symptoms such as cerebella ataxia, ocular motor symptoms, dysfunction of the autonomic nervous system, positive pyramidal signs, apraxia and early postural instability. Fluctuations of consciousness and the development of a dementia in early stages of the disease also point against idiopathic Parkins, disease. In addition to clinical symptoms, structural and functional imaging techniques, tests for L-dopa responsiveness and the evaluation of autonomic dysfunction help to increase the diagnostic accuracy. In this review we recommend a step-by-step rational procedure for the accurate diagnosis of Parkinsonian syndromes.
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