Diagnostic pitfalls in Parkinson's disease: case report

Abstract

Parkinson's disease (PD) is characterized by resting tremor, rigidity and bradykinesia. In 80% of cases, the disorder begins with upper limb resting tremor. However, there are some presenting atypical features that make the diagnosis even more difficult and intriguing. The disorder can have its onset below 40 years old, characterizing early-onset parkinsonism, which differential diagnosis possibilities are varied. Atypical presentations include a pure akinetic-rigid syndrome, the initial manifestations occurring in the lower limbs, and pain as the most important or sole manifestation. These atypical features are unusual, but can be seen in clinical practice. We present a 37 years old woman with early-onset parkinsonism beginning with an akinetic-rigid syndrome in the lower limbs whose first symptom was left leg pain, which diagnosis was made after 4 years of onset and after 16 referrals to several experts in different fields. We discuss these atypical features and the diagnostic pitfalls in PD.

Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease

“…PD is characterized by a combination of at least 2 of the three cardinal signs of Parkinson' s syndrome: resting tremors, rigidity and bradykinesia 3 . In PD, for more than two decades, sensory dysfunctions with variable intensities in smell, visual perception of colours and contrasts, proprioception and motor control have been described 4 .…”

Descobrindo a Doença de Parkinson: impacto para o parkinsoniano e seu familiar

“…Contudo, alguns sintomas não clássicos também costumam aparecer e isto pode dificultar e até retardar o diagnóstico, principalmente naqueles indivíduos que desenvolvem o parkinsonismo precoce, ou seja, antes dos 40 anos. Um destes sintomas é a dor, muito comum em outras patologias e que confunde os próprios profissionais (11) . Os sinais e sintomas são percebidos, muitas vezes, primeiramente pela família.…”

“…Posteriormente ocorre o aparecimento de rigidez, bradicinesia e instabilidade (11) . Os sinais e sintomas são percebidos, muitas vezes, primeiramente pela família.…”