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Extra-pyramidal disease

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Diagnostic Tests in Neurology

Part of the book series: Diagnostic Tests Series ((DTS))

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Abstract

The clinical triad of bradykinesia, tremor and rigidity is felt to be sufficient to diagnose idiopathic Parkinson’s disease, the assumption being made that the underlying pathology is centred on the zona compacta of the substantia nigra. That assumption is probably correct in the majority of patients with this clinical picture, though it is likely that other neuropathological disorders, generally undiagnosable in life, can present with a similar pattern of disability. Drug-induced Parkinsonism may be indistinguishable from the idiopathic form, though tremor is less conspicuous. The clinical spectrum of post-encephalitic Parkinsonism is broader, whilst extrapyramidal features are only a part of the disorder accruing from multi-infarction. The frequency with which dementia occurs in Parkinson’s disease, and its severity, remains a matter of debate. One reviewer has suggested that one third of Parkinsonian patients become demented in the later stages of the disease [1], based on a study which recorded moderate to marked dementia in 32% of 520 patients [2]. Included among these patients, however, were some with atypical features (wasting, cerebellar tremor, dystop1a or pyramidal signs), though, even in these, the parkinsonian features predominated. Though the authors claimed that dementia was as likely in the typical as in the atypical cases, another paper, including 93 patients, came to the opposite conclusion. There, an organic mental syndrome (principally dementia) was found in 15% of typical but in 68% of atypical cases [3].

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  1. Department of Neurology, Charing Cross Hospital, London, UK

    G. D. Perkin

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© 1988 G.D. Perkin

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Perkin, G.D. (1988). Extra-pyramidal disease. In: Diagnostic Tests in Neurology. Diagnostic Tests Series. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-3320-1_5

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  • DOI: https://doi.org/10.1007/978-1-4899-3320-1_5

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-412-28400-7

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