Parkinson’s disease (PD) is one of the most frequent chronic neurodegenerative disorders in neurological practice. This condition has well recognized diagnostic criteria such as at least bradykinesia with one or more of the following: 4 to 6 hertz rest tremor, muscular rigidity, and loss of postural reflexes. However, on unusual occasions, the classical clinic is not very evident, and the initial symptoms of PD can lead to diagnostic confusion. One of these symptoms is Postural Instability (PI); which is classically presented in advanced stages; but can also do it early in this condition; and can be confused with dizziness and vertigo; delaying the diagnosis of PD, and the onset of symptomatic treatment. We present three patients with nonspecific clinic, who did consulting for second medical opinion for dizziness, vertigo or PI; and after a detailed anamnesis and physical examination, the diagnosis of early PD was concluded. We review the pathophysiology of PI in PD, and want to keep attention - especially to non-specialist physicians - that in the differential diagnoses of dizziness-vertigo, PD may be included; and keep in mind, that this form of presentation, with early PI, may indicate a variant of the PD that predicts a greater PD severity.
Vertigo; Dizziness; Postural instability; Parkinson´s disease; Differential diagnosis