Differentiating Parkinson’s disease and atypical parkinsonism on clinical parameters is challenging, especially in early disease courses. Here, we discuss when brain MRI should be performed in the diagnostic work-up of parkinsonism, our preferred brain MRI scanning protocol, and the diagnostic value of specific abnormalities.
Tremor in Parkinson's disease can come in many different forms, and it has a highly variable appearance. This stimulated us to summarize a few crucial points as well as helpful tips and tricks for a good tremor evaluation.
In early disease stages, it can be difficult to differentiate clinically between Parkinson’s disease and the various forms of atypical parkinsonism, like multiple system atrophy or progressive supranuclear palsy. Balance impairment in the medio-lateral plane (i.e. sideways) is often seen in patients with a form of atypical parkinsonism, but not in patients with Parkinson’s disease.
This is reflected by the distance between the feet during gait, which is typically normal (or even narrow) in Parkinson’s disease, but widened in atypical parkinsonism. Estimating this stance width depends on subjective judgement, and is difficult to quantify in clinical practice.
Postural instability is a disabling feature of Parkinson’s disease (PD), contributing to recurrent falls and fall-related injuries. The retropulsion test is widely regarded as the gold standard to evaluate postural instability, and is therefore a key component of the neurological examination in PD.