Serie de casos de parkinsonismo atípico en Lima, Perú: características clínicas, evolución funcional y hallazgos de imagen

Abstract

Introduction

Atypical parkinsonian syndromes (APS) are neurodegenerative disorders marked by rapid progression and a poor response to levodopa. Evidence describing their features in Latin American populations is scarce. This study describes clinical manifestations, functional course, and neuroimaging findings in a cohort of patients with APS at a referral center in Lima, Peru.

Methods

We conducted an observational, descriptive, retrospective study of patients diagnosed with APS seen between January 2020 and December 2024. Sociodemographic, clinical, neuroimaging (MRI/CT), and functional progression data were abstracted from medical records. Diagnoses were based on Movement Disorder Society criteria for Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP), and the Armstrong criteria for Corticobasal Degeneration (CBD).

Results

Thirteen patients were included (9 male), with a mean age at diagnosis of 60.46 ± 11.24 years. The most frequent initial symptoms were gait impairment (13/13) and dysarthria (12/13). The most common final diagnosis was MSA (7/13), predominantly the cerebellar subtype (MSA-C), followed by PSP (4/13) and CBD (2/13). Characteristic neuroimaging signs such as the “hot cross bun” sign and the “hummingbird” sign were observed in MSA and PSP, respectively. During follow-up, eight required a wheelchair, and four patients died.

Conclusion

This case series underscores the clinical heterogeneity of APS and the substantial functional burden they impose. The findings reinforce the importance of clinical red flags and structural neuroimaging for differential diagnosis in resource-limited settings, contributing valuable data to characterize these disorders in Latin America.