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Parkinson's Disease

Parkinson`s Disease or Arthritis

04/16/2007

Question:

My father was referred to a Neurologist beause he supposedly had a stoic face. The Neurologist asked him if he had any stiffness to which my father said yes because he has had a arthritic degenerating left hip for years and it is hard for him to walk because the joint doesn`t rotate do he immediately prescribed Sinemet and diagnosed him with Parkinson`s Disease. Dad has fallen and it is always when he steps with his left leg. When he loses his balance it is to the left. Should we get a second opinion. When asked the Neurologist said that he didn`t do any test on him just prescribed the Sinemet because dad said he is stiff in the morning. We have confirmed that he has an arthritic him and spine from his thorax to his neck.

Answer:

There are many conditions (arthritis, spinal stenosis, neuropathy, metabolic problems) that can cause stiffness and gait disturbance in the elderly.  All of these should be taken into consideration when examining someone with gait problems.  Doing lab work and an MRI may be considered in a patient that is not clearly manifesting the cardinal features of PD.  These include rigidity (stiffness), bradykinesia (slowness), tremor and postural imbalance.  Not all of these are present in everyone, but this is the basis of diagnosis.  Doing lab work or imaging studies are to rule out any other causes of the symptoms. 

If you have any doubts or questions at all, certainly a second opinion is reasonable.  It would be recommended that the patient be evaluated by a Movement Disorders neurologist.

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Response by:

Karen M Thomas, DO Karen M Thomas, DO
Formerly:
College of Medicine
The Ohio State University