Parkinson’s Plus Syndromes - Clinical Dilemmas Regarding Parkinson's Disease: A Case Report

Ankica Grujevska; Daniela  Ristikj-Stomnaroska; Anastasija  Angelovska

doi:10.3889/oamjms.2025.12007

Authors

Ankica Grujevska Faculty of Medical Sciences, Goce Delchev University, Shtip, Republic of North Macedonia
Daniela Ristikj-Stomnaroska Faculty of Medical Sciences, Goce Delchev University, Shtip, Republic of North Macedonia; Department of Neurology, City General Hospital "8th September", Skopje, Republic of North Macedonia https://orcid.org/0009-0003-8439-8828
Anastasija Angelovska Faculty of Medical Sciences, Goce Delchev University, Shtip, Republic of North Macedonia https://orcid.org/0009-0007-4922-4397

DOI:

https://doi.org/10.3889/oamjms.2025.12007

Keywords:

Parkinson-plus syndrome, Progressive Supranuclear Palsy, Case report

Abstract

BACKGROUND: Parkinson-plus syndrome is a clinical entity characterized by symptoms and signs of damage to the extrapyramidal system (bradykinesia, tremor, rigidity, and postural instability), pyramidal tracts (spasticity, hyperreflexia), the cerebellum, and the autonomic nervous system. This group includes Corticobasal Degeneration, Progressive Supranuclear Palsy, and Multiple System Atrophy. Parkinson-plus syndromes have different clinical presentations, courses, and prognoses compared to Parkinson's disease, emphasizing the importance of precise diagnosis.

CASE PRESENTATION: A 46-year-old female patient presented acutely with symptoms including speech and swallowing difficulties, general weakness, malaise, left-sided hemiparesis, and gait instability with a tendency to fall backward. Neurological examination revealed dysarthric and soft speech, hypomimia, left-sided spastic hemiparesis, bradykinesia, rigidity, postural instability, and dysautonomic symptoms like hyperhidrosis, gastroparesis, and arterial hypotension. Routine blood analyses, thyroid hormones, immunological analyses, paraneoplastic antibodies, and virological serology were normal. MRI of the brain showed an arachnoid cyst in the right temporal region without parenchymal changes; echocardiography, carotid artery Doppler ultrasound, cytochemical analysis, and electrophoresis were normal.

CONCLUSION: The presence of dominant extrapyramidal symptomatology, postural instability, and backward falls suggests Progressive Supranuclear Palsy (PSP) as the most likely diagnosis.

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