Idiopathic Parkinson's disease — SCE Neurology MCQ

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EasyMovement DisordersIdiopathic Parkinson's diseaseSCE Neurology

A 48-year-old man presented with progressive slowness and reduced right arm swing over two years. On examination, there was asymmetric rest tremor, cogwheel rigidity and bradykinesia. Initial investigations showed: DaTSCAN showed reduced left striatal uptake. What is the most likely diagnosis?

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Correct answer: A — Idiopathic Parkinson's disease

Idiopathic Parkinson's disease is the best answer because the vignette describes Idiopathic Parkinson's disease: asymmetric bradykinesia with rest tremor and dopaminergic deficit fits Parkinson's disease. Restless legs syndrome is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Levodopa-induced dyskinesia and Hemifacial spasm are less appropriate because they would require different localisation, timing or test findings; Tourette syndrome would fit a different syndrome. Clinical pearl: essential tremor is action-predominant without bradykinesia.

Reference: NICE NG71; Movement Disorder Society consensus criteria