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

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.