Parkinsons plus syndromes

Question 1

progressive supra nuclear palsy

Answer 1

Early postural instability and vertical gaze palsy +/- falls, rigidity of trunk over limbs, symmetrical onset, speech and swallowing problems, little tremor

Question 2

Multy system atrophy (Shy- Drager)

Answer 2

Early autonomic features- impotence/incontinence, postural decrease in BP, cerebellar and pyramidal signs, rigidity> tremor

Question 3

Lewy body dementia

Answer 3

visual hallucinations and early dementia

Question 4

Cortico-basal degeneration

Answer 4

Akinetic rigidity involving one limb; cortical and sensory loss, apraxia “alien limb phenomenon”

Question 5

Vascular parkinsonism

Answer 5

diabetic/hypertensive patient who falls/has gait problems eg ataxia

Question 6

Normal pressure hydrocephalus

Answer 6

not really Parkinson’s plus

Triad of- dementia, dementia, bradyphrenia, urinary incontinence and gait abnormality