Ordinarily, the recognition of the parkinsonian state of chronic epidemic encephalitis is unattended by difficulty or uncertainty. Yet, in my experience, incipient and fragmentary forms of the disorder have offered diagnostic difficulties because of the uncertainty and paucity of physical signs. With this experience in mind, I have closely scrutinized and studied many patients suffering with varying degrees of parkinsonism to determine the constancy of early symptoms and signs.
Subjective evidence of ill health antedates the appearance of objective signs in most instances; an exception will be noted in the case reported. At this stage of experience with this comparatively new disease, however, one cannot venture a diagnostic structure of symptoms alone.
Of the physical signs, it has been found that postural and tonetic changes in the hands occur earliest and with greatest constancy and more often unilaterally. In order to facilitate their ready recognition, three tests have been used
ORNSTEEN AM. INCIPIENT PARKINSONISM: A DIAGNOSTIC TRIAD FOR ITS EARLY RECOGNITION. Arch NeurPsych. 1929;22(4):709–713. doi:10.1001/archneurpsyc.1929.02220040064007
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