1. Clinicopathological Conference CPC #7 Feb 26, 2008 The Johns Hopkins Hospital Hurd Hall 12 Noon Clinical Discussant: Zoltan Mari, MD Radiologist: Doris Lin, MD Pathology Resident: Lisa Stoll, MD, MPH Moderator: Charles Wiener, MD Zoltan Mari, M.D. Assistant Professor in Neurology Johns Hopkins University School of Medicine

2. My Contact Info Email: zmari1@jhmi.edu Email: zmari1@jhmi.edu Mail: 600 N. Wolfe Street, Meyer 6-119B, Baltimore, MD 21287 Mail: 600 N. Wolfe Street, Meyer 6-119B, Baltimore, MD 21287 Phone: 410-502-0133 (Rebecca Williams) Phone: 410-502-0133 (Rebecca Williams) Fax: 410-502-0570 Fax: 410-502-0570 Web: http://www.hopkinsneuro.org/movement%5Fdisorders/doc.cfm?i=136 Web: http://www.hopkinsneuro.org/movement%5Fdisorders/doc.cfm?i=136

3. Overview Patient Presentation Patient Presentation Patient Presentation Patient Presentation Differential Diagnosis Differential Diagnosis Differential Diagnosis Differential Diagnosis Secondary Causes of Parkinsonism Secondary Causes of Parkinsonism Secondary Causes of Parkinsonism Secondary Causes of Parkinsonism

4. Patient Presentation Chief Complaint: Unsteady Gait Chief Complaint: Unsteady Gait HOPI HOPI Exam and Workup Exam and Workup Clinical Course Clinical Course Summary Summary

5. Differential Diagnosis Parkinsonism Parkinsonism Weakness Weakness – Neuronopathy – ALS – Lyme – Neurosyphilis Psychiatric Illness Psychiatric Illness – Catatonia – Depression – Conversion disorder Ataxia Ataxia Demyelination Demyelination

6. Secondary Causes of Parkinsonism Drug-Induced Parkinsonism Drug-Induced Parkinsonism Toxic Parkinsonism Toxic Parkinsonism Parkinsonism due to Structural Lesions Parkinsonism due to Structural Lesions Infectious Parkinsonism Infectious Parkinsonism Metabolic Parkinsonism Metabolic Parkinsonism Post-Traumatic Parkinsonism Post-Traumatic Parkinsonism