Single-patient case report showing functional neuroimaging clarified a diagnosis of idiopathic Parkinson's disease versus atypical parkinsonism and guided multidisciplinary treatment including levodopa.

Limited value for discovery of new therapeutics, but modest translational utility for diagnostic stratification and ensuring appropriate treatment and trial enrollment through imaging-based differentiation.

INTRODUCTION: Parkinson's disease (PD) is the second leading neurodegenerative disorder in the world. The diagnosis of idiopathic Parkinson's disease (IPD) is mainly through clinical presentation of motor and non-motor symptoms. Motor symptoms include tremor, bradykinesia and rigidity. Atypical parkinsonism may pose a challenge in diagnosing IPD. Functional neuroimaging can assist in diagnosing IPD and in differentiating it from atypical parkinsonism due to other neurodegenerative aetiologies. PATIENT PRESENTATION: We present a case report of a patient with atypical parkinsonism and mild neurocognitive disorder. MANAGEMENT AND OUTCOME: Neuroimaging revealed IPD, distinguishing it from other causes of neurocognitive disorders. The patient received multidisciplinary team (MDT) input and appropriate medication, including a fixed combination of carbidopa and levodopa, rivastigmine, venlafaxine and quetiapine with improvement of his symptomatology. CONCLUSION: Neuroimaging assisted in establishing the diagnosis and guiding treatment. CONTRIBUTION: Although evidence and studies are needed for definitive use in clinical practice, there is supportive evidence to suggest the diagnostic utility of these modalities in parkinsonian syndromes.