====== Secondary parkinsonism ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1bo4uOs-bB_2LOe0MIHcZ5P2DrLtv8NvNY9ClUqdJ-kCZJ_Mfe/?limit=15&utm_campaign=pubmed-2&fc=20240812182354}}

Secondary [[parkinsonism]] is when [[symptom]]s similar to [[Parkinson's disease]] are caused by certain [[medicine]]s, a different nervous system disorder, or another illness.

Parkinsonism refers to any condition that involves the types of movement problems seen in [[Parkinson’s disease]]. These problems include [[tremor]]s, slow movement, and stiffness of the arms and legs.

The differential diagnosis of [[Parkinson’s disease]] includes the following etiologies of secondary parkinsonism or Parkinson-like conditions (sometimes of these are occasionally referred to as “Parkinson plus” syndromes or parkinsonian disorders).
----
A case report describes a 67-year-old woman who had received adoptive [[immunotherapy]] with chimeric antigen receptor T cells for [[multiple myeloma]] and was experiencing [[parkinsonism]]-like symptoms
((Gudera JA, Baehring JM, Karschnia P. Parkinsonism Following [[Chimeric Antigen Receptor]] [[T Cell]] [[Therapy]]. JAMA Neurol. 2024 Aug 12. doi: 10.1001/jamaneurol.2024.2506. Epub ahead of print. PMID: 39133506.)).

===== General information =====

The [[differential diagnosis]] of [[Parkinson’s disease]] includes the following etiologies of secondary [[parkinsonism]] or Parkinson-like conditions (these are sometimes referred to as “Parkinson plus” syndromes or parkinsonian disorders):

1. olivopontocerebellar degeneration (OPC)

2. striato-nigral degeneration (SND): more aggressive than parkinsonism

3. [[postencephalitic parkinsonism]].

4. [[progressive supranuclear palsy]] (PSNP): impaired vertical gaze 

5. multiple system atrophy (Shy-Drager syndrome)

6. drug induced: includes:

a) prescription drugs(elderly females seem more susceptible)

● antipsychotics (AKA neuroleptics): haloperidol (Haldol®) which works by blocking postsynaptic [[dopamine receptor]]s

● phenothiazine antiemetics: prochlorperazine (Compazine®)

● metoclopramide (Reglan®)

● reserpine

[[MPTP]] 


7. toxic: poisoning with

a) carbon monoxide: symmetric low densities in the globus pallidus on CT

b) manganese:may be seen in miners, welders, and pyrotechnics workers.Manganese is
excreted by the liver, ∴ people with hepatic insufficiency are more susceptible. Imaging: symmetrical high signal abnormalities on T1WI primarily in the globus pallidus with essentially no findings on T2WI or GRASS (almost pathognomonic)

8. ischemic (lacunes in basal ganglia): produces so-called arteriosclerotic parkinsonism AKA vascular parkinsonism: “lower-half” parkinsonism (gait disturbance predominates
((Lang AE, Lozano AM. Parkinson's Disease. First of Two Parts. N Engl J Med. 1998; 339:1044–1053))).
It also causes pseudobulbar deficits, emotional lability. Tremor is rare

9. posttraumatic: parkinsonian symptoms may occur in chronic traumatic encephalopathy, see dementia pugilistica (p. 962). There are usually other features not normally present in IPA (e.g. cerebellar findings)
10. normal pressure hydrocephalus(NPH):urinary incontinence...

11. neoplasm in the region of the substantia nigra

12. Riley-Day(familial dysautonomia).

===== Tremor in meningioma =====
[[Tremor in meningioma]].