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    Secondary parkinsonism

    Parkinsonism - secondary; Atypical Parkinson disease

    Secondary parkinsonism is similar to Parkinson disease. But the symptoms are caused by certain medicines, a different nervous system disorder, or another illness.

    Parkinsonism refers to any condition that involves the types of movementproblems seen in Parkinson disease. These problems include tremors, slow movement, and stiffness of the arms and legs.

    Causes

    Secondary parkinsonism may be caused by health problems, including:

    • Brain injury
    • Diffuse Lewy body disease (a type of dementia)
    • AIDS
    • Encephalitis
    • HIV/AIDS
    • Meningitis
    • Multiple system atrophy
    • Progressive supranuclear palsy
    • Stroke
    • Wilson disease

    Other causes of secondary parkinsonism include:

    • Brain damage caused by anesthesia drugs (such as during surgery)
    • Carbon monoxide poisoning
    • Certain medicines used to treat mental disorders or nausea
    • Mercury poisoning and other chemical poisonings
    • Overdoses of narcotics
    • MPTP (a contaminant in some street drugs)

    There have been cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin. These cases are rare and have mostly affected long-term drug users.

    Symptoms

    Common symptoms include:

    • Decrease in facial expressions
    • Difficulty starting and controlling movement
    • Loss or weakness of movement (paralysis)
    • Soft voice
    • Stiffness of the trunk, arms, or legs
    • Tremor

    Confusion and memory loss may be likely in secondary parkinsonism. This is because the diseases that cause secondary parkinsonism often lead to dementia.

    Exams and Tests

    The health care provider will perform a physical exam and ask questions aboutthe person'smedical history and symptoms.Be aware thatthe symptoms may behard to assess, particularly in the elderly.

    Examination may show:

    • Difficulty starting or stopping voluntary movements
    • Tense muscles
    • Problems with posture
    • Slow, shuffling walk
    • Tremors (shaking)

    Reflexes are usually normal.

    Tests may beordered to confirm or rule out otherproblems that can cause similar symptoms.

    Treatment

    If the condition is caused by a medicine, the doctor may recommend changing or stopping the medicine.

    Treating underlying conditions such as stroke or infections can reduce symptoms.

    If symptoms make it hard to do everyday activities,the doctor may recommend medicine. Medicines used to treat this condition can cause severe side effects. It is important to see the doctor for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson's disease.

    Outlook (Prognosis)

    Unlike Parkinson disease, secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Brain problems, such as Lewy body disease, are not reversible.

    • Difficultydoing daily activities
    • Difficulty swallowing (eating)
    • Disability (varying degrees)
    • Injuries from falls
    • Side effects of medications used to treat the condition

    Side effects from loss of strength (debilitation):

    • Breathing in food, fluid, or mucus (aspiration
    • Blood clot in a deep vein (deep vein thrombosis)
    • Malnutrition

    When to Contact a Medical Professional

    Call the health care provider if:

    • Symptoms of secondary parkinsonism develop, come back, or get worse
    • New symptoms appear, including confusion, movements that cannot be controlle
    • You are unable to care for the person at home after treatment starts

    Prevention

    Treating conditions that cause secondary parkinsonism may decrease the risk.

    People taking medicines that can cause secondary parkinsonism should be carefully monitored by the doctor to prevent the condition from developing.

    References

    Lang AE. Parkinsonism. In: Goldman L, Schafer AI. Goldman’s Cecil Textbook of Medicine.24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 416.

    Robottom BJ, Shulman LM, Weiner WJ. Drug-induced movement disorders: Emergencies and management. Neurol Clin. 2012;30:309–320.

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      • Central nervous system

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      Self Care

        Tests for Secondary parkinsonism

          Review Date: 9/25/2013

          Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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