Parkinsonian Syndromes

Question 1

Progressive supranuclear palsy

Answer 1

supranuclear opthalmoplegia with limitation of vertical more than horizontal gaze; axial rigidity and neck extension; early falls as a consequence of impaired postural reflexes, neck extension and inability to look down

Question 2

Corticobasal ganglionic degeneration

Answer 2

apraxia, cortical sensory impairment, and alien-limb phenomenon, severe unilateral rigidity, stimulus-sensitive mechanisms

Question 3

Diffuse Lewy body disease

Answer 3

early dementia; prominent visual hallucinations; extreme sensitivity to extrapyramidal side effects of antidopaminergic neuroleptic drugs

Question 4

Vascular parkinsonism

Answer 4

‘lower-half’ parkinsonism with ridigity in the legs and marked gait impairment; other evidence of diffuse vascular disease (corticospinal tract dysfunction, pseudobulbar palsy)

Question 5

Multiple system atrophy

Answer 5

early and prominent features of autonomic dysfunction; evidence of corticospinal tract dysfunction; cerebellar signs; stimulus-sensitive myoclonus; vocal cord paresis