Drugs, Toxins and Pugilism May All Lead to PD-Like Symptoms
D'Arcy L. Little, MD, CCFP
Director of Medical Education
York Community Services,
Toronto, ON
Introduction
Diagnosing a patient with Parkinson's disease might, at first, seem to be straightforward. In some cases, a medical student can make the diagnosis from across a room. However, fully one quarter of the diagnoses of idiopathic Parkinson's, which were made clinically by specialists, were found upon pathological examination to be some other disease.1,2,3 This figure is even higher in situations where the diagnosis was made in the early stages of the disease, by a non-specialist.3 Given that the list of conditions in the differential diagnosis of Parkinson's is vast, and the diagnosis is essentially a clinical one made by the process of elimination or exclusion, the clinician needs a solid approach when considering a diagnosis of this illness. The purpose of this review is to itemize an approach to the exclusion of cases of secondary parkinsonism, in the diagnosis of idiopathic Parkinson's disease (See Figure 1: Approach to Diagnosis of Parkinsonism). Table 1 lists clues that suggest a diagnosis of secondary parkinsonism.
