Co-morbid demyelinating lesions and atypical clinical features in a patient with Parkinson's disease.

Highlights from the article: As advanced age is one of the few risk factors for PD, with longer life expectancy MS patients could be at risk of developing PD [[3]]. First, an acute reversible parkinsonism could appear in a patient with relapsing-remitting MS secondary to a new demyelinating lesion in a strategic location (globus pallidus, thalamus, substania nigra and nucleus ruber), often steroid-responsive. However, no such lesions were observed in our patient and clinical evolution did not support RR-MS. Second, a gradual and progressive parkinsonism could represent one symptom of primary or secondary progressive MS involving the basal ganglia, but this was also not observed at postmortem investigation. However, MS-type plaques may have influenced the severity of the patient's PD symptoms, the poor response to antiparkinsonian drugs (anticholinergic, l-Dopa, rasagiline), and also other atypical symptoms, such as pyramidal signs and the early urinary incontinence [[3]].