# Onset of Parkinson’s Disease Identified Through Hyperhidrosis: A Middle-Aged Woman Case Report

## TL;DR

A middle-aged woman's Parkinson's disease was identified through non-motor symptoms like hyperhidrosis, highlighting the importance of thorough symptom assessment.

## Contribution

Highlights the role of physiotherapists in identifying non-motor symptoms of Parkinson's disease in women.

## Key findings

- Hyperhidrosis was a key non-motor symptom leading to PD diagnosis in a woman.
- Physiotherapists can play a crucial role in identifying neurodegenerative diseases through symptom assessment.
- Non-motor symptoms in women with PD may appear earlier and more subtly than motor symptoms.

## Abstract

Background and Clinical Significance: Parkinson’s disease (PD) is a neurodegenerative condition characterized by motor and non-motor symptoms, which significantly impact patients’ autonomy and quality of life levels. Basically, the PD diagnosis is clinical and, in some cases, can be challenging to diagnose due to the heterogeneity of the symptoms. Case Presentation: A 58-year-old woman who, during the COVID-19 lockdown, referred to experiences of slight tremor and stiffness in her left hand at rest, but without any other associated symptoms. Firstly, after consulting a general practitioner (GP), the patient was diagnosed with cervical radiculopathy (CR), presented as essential tremor and stiffness to the hand. Nevertheless, during the initial physiotherapy evaluation, the motor symptoms did not fully align with the diagnosis of CR. For this reason, the presence of non-motor symptoms was thoroughly investigated. Notably, hyperhidrosis was identified as a significant non-motor symptom, leading to the patient’s subsequent referral to a neurologist, who finally diagnosed PD. Conclusions: This case report highlights the essential role of physiotherapists in conducting independent assessments and comprehensive investigations of all patients’ symptoms, even when a medical diagnosis has already been established. This is particularly crucial when there is suspicion that musculoskeletal symptoms may be indicative of neurodegenerative diseases such as PD, which is well-known for its extensive array of non-motor symptoms. Especially in women with PD, non-motor symptoms tend to emerge earlier and in a more subtle manner than motor symptoms, making diagnosis challenging. Therefore, meticulous anamnestic data collection is essential, especially by physiotherapists working in direct-access settings.