A 65-year-old woman presents with a 2-month history of progressive bradykinesia, rigidity, and resting tremor. Her symptoms are symmetric. She was recently started on metoclopramide for gastroparesis. There is no cognitive decline. What is the most likely etiology of her parkinsonism?

• A Idiopathic Parkinson's disease
• B Drug-induced parkinsonism ✓
• C Dementia with Lewy bodies
• D Vascular parkinsonism

Explanation

Metoclopramide is a dopamine D2 receptor antagonist. Drug-induced parkinsonism typically presents symmetrically, unlike idiopathic Parkinson's disease which is asymmetric. Symptoms usually resolve after stopping the offending drug. The temporal relationship with metoclopramide is the key discriminator.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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