Diagnostics of atypical parkinsonian syndromes, also called parkinsonian syndromes “plus”, is, in spite of modern diagnostic methods progress, a clinical challenge. It concerns rare, chronic neurodegenerative diseases of an unknown etiology, unknown causative treatment and often symptomatic treatment of little effectiveness. The terms atypical parkinsonian syndrome and parkinsonian syndrome “plus” are related to the possibility of parkinsonian symptoms occurrence other than typical for idiopathic Parkinson’s disease (PD) and additional, nonparkinsonian, symptoms occurrence. The diagnosis of these diseases, similar to PD, is based on the history of the disease, clinical evaluation, prospective patient’s observation and exclusion of secondary parkinsonims. The most difficult moment in differential diagnostics between PD and atypical parki- nsonian syndrome, as well as between particular atypical syndromes, is the most often the beginning of the disease. Clinical observation and readiness to verify the diagnosis in the course of the disease is important. In the typical course of PD some symptoms (e.g. escalated posture instability, falls, dementia, visual hallucinations not related with treatment and others) occur in the advanced stage but their early occurrence (in the first 3 years from the onset of the disease) is treated as atypical and should induce diagnostic alertness (1, 2).

One of the symptoms commonly observed in the advanced PD is a phenomenon of freezing of gait, also called motor block. It is a levodopa unresponsive parki nsonian feature, which may be the manifestation of the off time and is defined as a sudden, transient inability to continue walking, inability to “move the feet from the ground”. It occurs mainly with change in the walking direction, walking through narrow spaces, avoiding obstacles and so on. It is often accompanied by festination, postural instability, falls and bradykinesia/akinesia (difficulty in starting and impoverishment of movement/inability to start movement – witch concernes different types of movement, not only walking). The symptom yields by itself after a while but it may be made easier by sensorial associations or accessory objects (3).

Freezing gait may also occur in atypical parkinsonian syndromes, e.g. progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD) and in many secondary brain diseases: in vascular parkinsonism, normotensive hydrocephalus, in frontal lobe tumor and others (3, 4).

The following report is to present the case of the patient with slowly progressive parkinsonian syndrome, in which hypokinesia and early (in the second year of the disease) freezing gait are predominant.

A 59-year-old male with higher education running his own company stays under care of Outpatient’s Clinic of Department of Neurology and Epileptology of Centre of Postgraduate Medical Education in Warsaw due to gradually progressing gait disorder and slowness of movements. The disease started 7 years ago, in the 52 year of age, with a slight slowing in walking, speech and writing and impoverishment of mimics. At the beginning the patient was suspected of depression and treated with venlafaxine by the psychiatrist but occurrence of festination in the first year of the disease caused the diagnostics to widen. In the physical examination parkinsonian syndrome was then diagnosed with predominance of walking disturbance with periodic festination (especially in initiation of walking, while turn back and in limited space) and movement slowing with micrographia.