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NEUROLOGY 2008;71:e11
© 2008 American Academy of Neurology
Resident and Fellow Section

Teaching Video NeuroImage:The "Fonzarelli" sign

Focal thumb dystonia as an early manifestation of Parkinson disease

Formula

Martin R. Turner, PhD, Lucy Matthews, MRCP and George C. Ebers, FMedSci

From the Department of Neurology (M.R.T., L.M.), John Radcliffe Hospital; and University Department of Clinical Neurology (G.C.E.), Oxford, UK.

Address correspondence and reprint requests to Dr Turner, Department of Neurology, West Wing Level 3, John Radcliffe Hospital, Oxford OX3 9DU, UK turnermr{at}doctors.org.uk

A 77-year-old man presented with a 1-year history of upper limb rest tremor, rigidity, and bradykinesia. He reported focal dystonia affecting the right thumb over the preceding 7 years, resulting in a constant "thumbs up" gesture reminiscent of the fictional television character Arthur Fonzarelli.1 Subsequent levodopa therapy reduced his bradykinesia and rigidity, but did not ameliorate the dystonia (see the video).

While foot dystonia is a common feature in late Parkinson disease (PD), dystonia may precede the development of PD by several years.2 Writer's cramp has been described as an early manifestation,3 with extension of the great toe also noted (the striatal foot).4

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.


   REFERENCES
Top.
 REFERENCES
 

  1. Fonzie. Available at: http://en.wikipedia.org/wiki/Fonzie.
  2. Ashour R, Tintner R, Jankovic J. Striatal deformities of the hand and foot in Parkinson's disease. Lancet Neurol 2005;4:423–431.[Medline]
  3. Katchen M, Duvoisin RC. Parkinsonism following dystonia in three patients. Mov Disord 1986;1:151–157.[Medline]
  4. Duvoisin RC, Yahr MD, Lieberman J, Autunes J, Rhee S. The striatal foot. Trans Am Neurol Assoc 1972;97.




This Article
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Right arrow Articles by Turner, M. R.
Right arrow Articles by Ebers, G. C.

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