Hemiplegic Parkinsons Disease

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Early neurologists considered Parkinson's disease to be a bilateral condition, but often commented on the mild asymmetry of tremor, especially in the early years of disease. Within the context of this asymmetric but bilateral archetype, they distinguished another form of Parkinson's disease that was highly asymmetric with prominent disability in the involved upper extremity beyond that expected with bradykinesia alone (3). Collectively termed hemiplegic Parkinson's disease, these cases form a large series in the French neurological literature of the late 19th century and include cases of abrupt strokelike onset as well as slowly progressive disability (9) (Fig. 3). They are discussed in the section on corticobasal degeneration, because they clinically fit best into this designation among the group of atypical parkinsonian disorders. Because infectious disease (abscess and hemorrhagic strokes especially from military tuberculosis) were frequent disorders in the 19th century, some of these cases may not have related to primary neurodegeneration. Furthermore, autopsy reports were not systematically recorded, so that analysis of cases as corticobasal degeneration remains only suggestive.

Fig. 2. Drawing by J-M Charcot comparing two patients: (left) typical Parkinson's disease with flexed posture and (right) another patient with an atypical variant of extended posture (4).
Corticobasal Degeneration
Fig. 3. Photograph from an article by Dutil (17) showing asymmetric parkinsonism suggestive of corticobasal degeneration but with an extended trunk and neck posture with gaze impairment suggestive of progressive supranuclear palsy.

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