The following information may have been posted at a prior time, but a
number of List members have requested this information.
                                                                Peace, John
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Mimics


                    Conditions Resembling PD

Initially Parkinson's Disease may be confused with a number of other
conditions, including:

Benign Essential Tremor. A common condition that may appear in the elderly
and slowly
progresses over the years. The tremor is usually equal in both hands and
increases when the hands are stretched out in front of the patient or when
the hands are moving. The tremor may involve the head but spares the legs.
Patients with Benign Tremor have no other Parkinsonian features and there
is usually a family history of tremor. Parkinsonian Tremor and Benign
Tremor generally respond to different drugs. A small number of patients
with Benign Essential Tremor (less than five percent) develop PD.

Shy Drager Syndrome. A condition in which the earliest and most severe
symptoms are those of insufficiency of the Autonomic Nervous System:
dizziness on standing, bladder difficulty, and impotence. These autonomic
symptoms are followed by PD symptoms such as rigidity tremor, bradykinesia,
postural instability, and gait difficulty. There is some question among
neurologists as to whether the Shy Drager Syndrome is a form of PD or a
separate disease.

Normal Pressure Hydrocephalus. An uncommon condition that consists of
difficulty in walking (resembling PD), mental changes (resembling
Senility), and urinary incontinence. The condition is caused by an
enlargement of the fluid cavities (Ventricles) in the brain which compress
the parts of the brain that regulate walking, thinking, and voiding. Normal
Pressure Hydrocephalus differs from the more familiar Hydrocephalus of
Childhood which results from a blockage to the flow of the spinal fluid. No
such blockage is found in patients with Normal Pressure Hydrocephalus.
There is no known cause of Normal Pressure Hydrocephalus. The condition may
respond to a shunt: a tube placed in the ventricle which drains off the
excessive fluid and carries it away.

Striato-Nigral Degeneration. An uncommon disorder in which patients become
stiff and slow and develop difficulty with balance and walking. Usually
patients do not have a tremor and cannot be distinguished from patients
with PD on the basis of a neurological exam. Patients with Striato-Nigral
Degeneration however do not respond to Levodopa. Only after death can this
disorder be distinguished from PD because in Striato-Nigral Degeneration
most of the damage is in the Striatum and not the Substantia Nigra. This is
the reverse of the situation with PD.

Pseudobulbar Palsy. A common disorder that occurs in patients with disease
of the blood vessels of the brain (Arteriosclerosis). Arteriosclerosis is
especially likely to occur in patients with high blood pressure or
diabetes. Patients who develop Pseudobulbar Palsy do so because they suffer
numerous small strokes (ministrokes), many of which are so mild that
patients are unaware of them. The ministrokes usually damage the part of
the brain that controls balance and walking,
the same area involved in PD. The two disorders may not be distinguished on
the basis of a neurological examination alone. Patients with Pseudobulbar
Palsy do not respond to antiparkinsonian drugs. In the past many patients
were thought to have PD on the basis of Arteriosclerosis alone
(Arteriosclerotic PD). Currently, Arteriosclerosis is not believed to be
the cause of PD.

Progressive Supranuclear Palsy. An uncommon disorder in which patients
develop paralysis of their eye movements, difficulty in speaking, rigidity,
and senility. This disorder causes changes in the brain that are similar to
those of PD, but are even more extensive. Patients with this condition do
not respond to antiparkinsonian drugs.

Wilson's Disease. A rare, inherited disorder that appears in patients below
the age of 40. This disease involves the Brain and the Liver. Wilson 's
Disease comes from an inherited lack of a blood protein, Ceruloplasmin,
which carries the small amounts of copper that are necessary for health.
The lack of Ceruloplasmin results in the accumulation of copper in the
Brain and in the Liver. This excess results in damage to these two organs.
Early diagnosis is important in this disease as treatment prevents further
damage to the Brain and Liver

Hallervorden Spatz Disease. Also a rare, inherited, progressive disease
that begins in late childhood. Hallervorden Spatz Disease is associated
with the accumulation of excessive iron in certain parts of the brain.
There is no treatment for this disease.

Olivopontocerebellar Degeneration. An uncommon disorder in which patients
have difficulty with balance and walking, often called Ataxia. The patients
may have an action or sustension tremor, but do not have rigidity or
bradykinesia. The disorder results from a deterioration of certain
structures in the nervous system, including the Cerebellum, the Pens (a
part of the Brain Stem), and the Olives (a part of the Brain Stem and the
Spinal Cord). Olivopontocerebellar Degenerations do not respond to
antiparkinsonian drugs.

Huntington's Disease. An inherited disease which usually begins in early
middle life. It is characterized by involuntary movements (dyskinesias,
chorea) associated with changes in behavior, personality, and mood. The
chorea (which resembles the involuntary movements caused by Levodopa) may
precede, occur simultaneously, or follow the mental changes. The disease,
when fully developed, is easily distinguished from PD. However, the
symptoms of a childhood form of Huntington 's Disease may resemble PD.
Levodopa usually worsens the symptoms of Huntington's Disease.

Dystonia. An inherited disease that begins in childhood and is progressive.
The patients develop unusual postures of the head and neck, body, arms, and
legs. This is called Generalized Dystonia (Dystonia Musculorum Deformans).
A variant of the disease, Segmental Dystonia, develops in adulthood and
involves only one part of the body, e.g. the head and neck (Torticollis or
Wryneck). Dystonia may rarely result from the use of certain drugs, such as
Phenothiazines. This type of dystonia Will disappear when the offending
drug is stopped.

Brain Tumors. Tumors of the Brain that are close to the Substantia Nigra or
the Striatum may exert local pressure on these structures. This local
pressure may, in turn, result in the appearance of symptoms that resemble
PD. A CT or NMR scan of the brain will exclude the possibility of a brain
tumor as the cause of the Parkinsonian symptoms.


                  Conditions Confused with PD

There are several relatively common neurological diseases that some
patients confuse with Parkinson 's Disease. Some of them include:

Multiple Sclerosis. A disease that begins in young adults and consists of a
series of attacks on the Myelin (fatty substance) of the white matter of
the central nervous system. Why these attacks occur is not clear. The
attacks may result in a loss of vision, double vision, dizziness, loss of
balance (Ataxia), paralysis, and bone and Bladder difficulty. There may be
remissions during which the symptoms disappear. However, several attacks
may damage the nervous system, resulting in permanent symptoms.

Amyotrophic Lateral Sclerosis (ALSO Lou Gehrig's Disease). Affecting more
men than
women, this disease begins in middle life. There is a progressive weakness
and shrinkage (Atrophy) of all the muscles of the body, including those
that control speaking, eating, and breathing. There is no known cause or
cure for this disease.

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Several disorders cause parkinsonism as a clinical component of disease.
Only about 76% of  patients clinically diagnosed as idiopathic Parkinson
disease actually have the disease.

     clinical features
          rigidity
          bradykinesia
          resting tremor
          abnormal postural reflexes

     common causes
          idiopathic Parkinson disease
          drug-related parkinsonism
          Alzheimer disease
          progressive supranuclear palsy
          multiple system atrophy
               Shy-Drager syndrome
               olivo-ponto-cerebellar atrophy
               striatonigral degeneration

     uncommon causes
          hydrocephalus
          Wilson disease
          cortico-basal degeneration
          Huntington disease
          Hallervorden-Spatz disease
          post-encephalitic parkinsonism
          manganese poisoning
          carbon monoxide poisoning

     commonly mistaken for Parkinson disease
          essential tremor
          vascular pseudo-parkinsonism
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