Secondary parkinsonism is when symptoms similar to Parkinson's disease are caused by certain medicines, 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 tremors, 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 1).
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 receptors
● phenothiazine antiemetics: prochlorperazine (Compazine®)
● metoclopramide (Reglan®)
● reserpine
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 2)). 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).