Abstract
The early clinical features of neurodegenerative parkinsonism can be subtle and often coexist with autonomic, sensory and psychic symptoms, making accurate early diagnosis challenging. We retrospectively assessed the initial, clinical presentation and referral patterns of 494 patients with a pathological diagnosis of parkinsonism (344 with Parkinson's disease (PD), 89 with progressive supranuclear palsy (PSP) and 61 with multiple system atrophy (MSA)) archived at the Queen Square Brain Bank, London. Forty-four per cent of all patients were initially referred to a neurologist. Of those with PD, 28% were referred to a general physician, and approximately 5% each to orthopaedic surgeons, urologists, psychiatrists and rheumatologists. Pain was common in those not initially referred to neurologists and most lacked early tremor, rigidity and bradykinesia. More PSP patients were initially referred to ophthalmologists than in PD (9 vs 1%, chi(2)P < 0.001) and more MSA patients were referred to a urologist or gynaecologist than in PD (21 vs 5%, chi(2)P < 0.001). In PD a frozen shoulder, degenerative spine disease and benign prostatic hypertrophy were the most common early diagnoses. In PSP, the most common misdiagnosis was PD, followed ...Continue Reading
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