The diagnosis of Parkinson’s disease is based on mostly clinical grounds, starting with resting tremors, starting with one side of the body progressing to the other side. Bradykinesia on examination, rigidity on examination, typical age group, all makes the diagnosis more easier, but there are certain times where there are atypical features. Sometimes diagnosis of Parkinson’s disease may be difficult in the initial part of the diagnosis , but other aspect is that even if it atypical Parkinson’s disease or typical Parkinson’s disease, the treatment is almost the same. if we want to be absolutely sure, then we take the help of some imaging modalities like MRI scans where in patients wherein patients with atypical Parkinsonism there can be atrophy of brain stem, highlighting certain areas of atrophy in certain structures of the brain like brains stem in MSA or PSP or there can be cortical atrophy in conditions where patient like CBGD or corticobasal ganglionic atrophy wherein you can have cortical atrophy along with certain features like dementia. So we take the help of MRI imaging in the diagnosis of atypical Parkinson’s disease. In typical Parkinson’s disease, usually MRI doesn’t show any features of degeneration early on, there can be later changes but we don’t depend on imaging. Sometimes we have to make early diagnosis of this conditions, differentiating between essential tremors or Parkinson’s disease. Then we take help of nuclear scans like DAT scan or PET scan were you see decreased uptakes of Dopa in basal ganglia with Parkinson’s disease. So we take help of nuclear scan and imaging for early diagnosis of Parkinson’s disease. For common type pf Parkinson’s disease where they behave typically in clinical presentation, we don’t need any investigation modalities. There are other secondary types of Parkinson’s disease where we need to take help of blood investigation. So we need to check sodium, check for subdural hematoma to check for Parkinson’s disease. So when other is atypical presentation of Parkinsonism, rapid onset of Parkinsonism, we need to take help of investigations in the form of electrolytes or imaging in or some of the atypical features like early onset like young age Parkinsonism, we ned to rule out other neurodegenerative conditions like Wilsons disease or other neurodegenerative disorders which have genetic basis. We need to look at this when there is an atypical presentation.

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