Atypical Young-onset Parkinsonism with Extensive White Matter Changes: A Neurophysiotherapy Case Report

Abstract

Aim: Clinically, Parkinson-plus syndromes are considered relatively uncommon in individuals younger than 40 years, making early-onset presentations particularly rare and clinically significant. Thus, the present case aims to describe a young adult with atypical parkinsonism and extensive white matter disease who demonstrated clinically meaningful progression from severe dependency towards functional independence. Case Presentation: A 30-year-old male presented with progressive imbalance, recurrent falls, bradykinesia, rigidity, freezing of gait, impaired postural control, and functional dependency over a two-year period. Neurological examination revealed masked facies, hypophonia, rigidity, exaggerated deep tendon reflexes, bilateral extensor plantar responses, ankle clonus, cerebellar incoordination, and severe gait dysfunction. Brain MRI demonstrated an absent swallow-tail sign with substantia nigra blooming, Fazekas grade III white matter changes, global cerebral atrophy, and chronic ischaemic foci. Discussion: Intervention- The patient underwent an intensive eight-week neurophysiotherapy rehabilitation programme (45–60 minutes per session over approximately two months) targeting cognitive-motor, postural, gait, and functional impairments. The intervention plan primarily incorporated action-imitation, external cueing strategies, and cognitive rehabilitation to improve comprehension, motor sequencing, and cognitive-motor integration. Outcomes- Clinically meaningful improvements were observed following rehabilitation. The Berg Balance Scale score improved from 9/56 to 36/56, the Dynamic Gait Index score improved from 1/24 to 12/24, the Functional Independence Measure score improved from 34/126 to 80/126, the UPDRS score decreased from 101/199 to 57/199, the SARA score improved from 33/40 to 19/40, and the Modified Hoehn and Yahr stage improved from stage 5 to stage 3 after two months of neurophysiotherapy treatment. Conclusion: This case highlights the response of a patient with atypical parkinsonism to structured neurophysiotherapy rehabilitation, with improvements in functional mobility, balance, and gait performance.