Secondary parkinsonian syndromes with various etiologies

Abstract

The parkinsonian syndrome is found not only in patients with Parkinson’s disease, but also in various other neurodegenerative and heredodegenerative diseases. Secondary parkinsonian syndrome may be caused by vascular diseases, brain tumours, brain trauma and hydrocephalia, inflammatory or metabolite diseases, intoxications and various drugs.
The vascular parkinsonism is most important for the clinical practice. However, the nosology of this disease is not clarified yet. Since 1929 when the theory of the „atherosclerotic parkinsonism” has been proposed, until 80th years a tendency for exaggeration the role of the vascular parkinsonism existed. Now it is well known, that vascular parkinsonism may cause about 3% of the parkinsonian syndromes. Vascular parkinsonism is accepted if wide spread lesions in the brain deep white matter are found.
The lethargic encephalitis has no practical importance for the parkinsonian syndromes with inflammatory aetiology nowadays. However single cases of acute parkinsonian syndrome during various encephalitis are still being reported. In the modern times more important is the parkinsonian syndrome in patients with AIDS and HIV encephalopathy, or after opportunistic infections.
Parkinsonian syndromes after various intoxications or drugs are becoming rarer nowadays. Anyway tumours and brain trauma are still important possible explanation for parkinsonian syndrome. Some rare heredodegenera tive diseases have also to be bared in mind in the differential diagnosis of parkinsonian syndromes. The stiff person syndrome is probably an autoimmune disease, but it was included in the group of secondary parkinsonian syndromes in order not to forget it in the differential diagnosis. In conclusion the finding of a parkinsonian syndrome doesn’t mean necessarily a Parkinson’s disease.
Sometimes a serious differential diagnosis is needed in order to find the correct diagnosis.