Parkinsonian syndrome !

Syndrome

Slowness of movement with a resting tremor, stiffness and problems with gait and balance.

Updated 2026-11-01

See it in 3D: Substantia nigra · Putamen · Globus pallidus · Caudate nucleus · Midbrain

What it is

Parkinsonism is a syndrome defined by bradykinesia (slow, reduced movement) together with a resting tremor or rigidity. It comes from a lack of dopamine in the basal ganglia circuit. The most common cause is Parkinson disease, but many cases are due to drugs that block dopamine, and recognising them matters because they are reversible.

Key findings

Bradykinesia: finger tapping becomes slow and progressively smaller.
Pull test (a tug backwards): assesses postural instability.
Red flags for another parkinsonism: early falls, early dementia, vertical gaze palsy, severe dysautonomia, symmetric onset.

Pathophysiology

Dopaminergic neurons of the substantia nigra pars compacta (midbrain) project to the striatum (caudate and putamen).
Their loss unbalances the direct and indirect basal ganglia pathways and slows the start of movement.
Motor symptoms appear only after a large share of these neurons has been lost.

Common causes

Idiopathic Parkinson disease.
Drugs: antipsychotics, metoclopramide and other dopamine blockers.
Vascular parkinsonism (mainly the legs), normal pressure hydrocephalus.
Atypical parkinsonisms: multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies.
Wilson disease in young people; toxins such as manganese or carbon monoxide.

Tests that confirm it

The diagnosis is clinical.
MRI rules out structural causes and points to atypical parkinsonisms.
A clear, sustained response to levodopa supports Parkinson disease.

Test yourself

Think of the answer, then tap the question to see it.

Which sign is required to call a syndrome parkinsonism?

Bradykinesia, together with a resting tremor or rigidity.

What is the most common secondary cause of parkinsonism?

Drugs that block dopamine, such as antipsychotics and some antiemetics.

Which tremor features suggest Parkinson disease?

A slow, resting, 'pill-rolling' tremor that lessens with movement and disappears during sleep.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Parkinson Disease (MSD Manual Professional Edition, 2024); Parkinson disease (MedlinePlus, U.S. National Library of Medicine, 2024); Walking abnormalities (MedlinePlus, U.S. National Library of Medicine, 2024).

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Representative model, for educational purposes only.