In the fight against neurophobia: Clinical confrontation and differential diagnoses of parkinsonism

Abstract

Introduction: Neurophobia is defined as the fear of neurosciences and clinical neurology, representing a challenge to be overcome in medical education for both undergraduate students and recently graduated professionals. Parkinsonisms are clinical syndromes characterized by the presence of bradykinesia, rigidity, and tremor. Although Parkinson’s disease is the most frequent diagnosis, other “atypical parkinsonisms” are of great clinical relevance and require thorough evaluation for diagnosis. Objective: To conduct a review of the main differential diagnoses of parkinsonisms, presenting a straightforward clinical approach aimed at combating neurophobia among medical students. Methodology: A non-systematic literature search of national and international indexed literature was carried out in order to present the information in an accurate and up-to-date manner. Result: Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration are the main differential diagnoses to consider in clinical assessment. Each of these can be clinically distinguished from Parkinson’s disease in terms of the rate of symptom onset, pattern of appearance, symptom predominance and imagenological findings. Furthermore, the prognosis of these conditions is generally poorer both in terms of pharmacological management and life expectancy. Conclusion: For medical students or general practitioners, parkinsonian syndromes can often seem overwhelming. However, a systematic approach focused on the timeline of symptom onset can be highly clarifying. Combined with the proper selection and interpretation of imaging studies, this allows the general practitioner to achieve a simple and direct understanding of the neurological condition.