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