Clinical signs and symptoms of Parkinsonian syndrome

1. Big picture

Parkinsonian syndrome, or parkinsonism, is a hypokinetic-rigid extrapyramidal syndrome caused by dysfunction of basal ganglia motor circuits, especially dopaminergic deficiency in the nigrostriatal pathway.

The key clinical definition:

Parkinsonism = bradykinesia plus rigidity and/or resting tremor, often with postural instability later.

The most important exam point:

The obligatory clinical sign is bradykinesia. Resting tremor is typical, but its absence does not exclude Parkinson disease.

The four cardinal motor signs are:

1. Bradykinesia / hypokinesia
2. Rigidity
3. Resting tremor
4. Postural instability