Differential diagnosis of parkinsonism

Parkinsonova bolest je složena neurodegenerativna bolest. Uzrok bolesti, kao i mehanizmi nastanka nisu u potpunosti razjašnjeni. Uglavnom se radi o kombinaciji nasljednih i okolišnih čimbenika, a rjeđe nalazimo specifične genske abnormalnosti. Bolest se manifestira poremećajem pokreta koji nastaje zbog gubitka dopaminergičkih neurona nigrostrijatalnog puta, a zahvaća i velik broj drugih regija mozga. Vodeći sindrom bolesti je parkinsonizam, hipokinetički poremećaj pokreta koji se klinički manifestira bradikinezom, rigorom, tremorom u mirovanju i gubitkom posturalnih refleksa. Dijagnoza Parkinsonove bolesti je predominantno klinička i temelji se na kombinaciji klinički utvrđenog parkinsonizma i suportivnih simptoma uz odsutnost atipičnih znakova. Konačna dijagnoza bolesti se postavlja post-mortem na temelju nalaza Lewyjevih tjelešaca u stanicama bazalnih ganglija i degeneraciji supstancije nigre. Parkinsonizam, međutim, nije isključivo vezan za Parkinsonovu bolest nego se može javiti i u čitavom nizu različitih bolesti i stanja pa govorimo o sekundarnom, atipičnom ili parkinsonizmu u sklopu neurodegenerativnih oboljenja. Iscrpna anamneza i detaljan klinički pregled potpomognuti kako slikovnim tako i laboratorijskim pretragama preduvjet su za postavljanje ispravne dijagnoze što u konačnici vodi ka boljoj kvaliteti života i produljenom životnom vijeku.
Parkinson's disease is a complex neurodegenerative disease. The cause of the disease, as well as the mechanism of its occurrence, have not been fully elucidated. It is mainly caused by combination of hereditary and environmental factors, and less often by specific genetic abnormalities. The disease is manifested by a movement disorder caused by the loss of dopaminergic neurons of the nigrostriatal pathway. A large number of other brain regions may be affected. The leading syndrome of the disease is parkinsonism, a hypokinetic movement disorder that is clinically manifested by bradykinesia, rigidity, tremor at rest, and postural instability. The diagnosis of Parkinson's disease is predominantly clinical, based on a combination of clinically established parkinsonism and supportive symptoms in the absence of atypical signs. The final diagnosis of the disease is made postmortem based on the finding of Lewy bodies in the cells of the basal ganglia and the degeneration of the grey matter. Parkinsonism, however, is not exclusively related to Parkinson's disease, but can also occur in a number of different diseases and conditions, so we are talking about secondary, atypical or parkinsonism as part of neurodegenerative diseases. A comprehensive history and detailed clinical examination, supported by both imaging and laboratory tests, are a prerequisite for making a correct diagnosis, ultimately leading to better quality of life and extended lifespan.