The Rolex sign - first manifestation of Parkinson's disease: case report

O sinal do Rolex - manifestação inicial da doença de Parkinson: relato de caso

THE ROLEX SIGN FIRST MANIFESTATION OF PARKINSON'S DISEASE

CASE REPORT

HÉLIO A. G. TEIVE^*, DANIEL S. SÁ^**

ABSTRACT - We describe a patient whose initial manifestation of Parkinson's disease was a malfunctioning of a self-winding wristwatch secondary to bradykinesia of his left arm. Andrade and Ferraz reported this sign in 1996, suggesting that it be called the Rolex sign.

KEY WORDS: Parkinson's disease, bradykinesia, Rolex sign.

O sinal do Rolex - manifestação inicial da doença de Parkinson: relato de caso

RESUMO - Relatamos o caso de um paciente com diagnóstico estabelecido de doença de Parkinson idiopática, cujo sinal inicial da doença foi a dificuldade de funcionamento de um relógio de pulso, da marca Rolex, em virtude da presença de bradicinesia no seu membro superior esquerdo. Esta peculiaridade semiológica já foi referida previamente por Andrade e Ferraz, em 1996, como o sinal do Rolex.

PALAVRAS-CHAVE: doença de Parkinson, bradicinesia, sinal do Rolex.

The clinical manifestation of Parkinson's disease is frequently subtle, making an early diagnosis a difficult task. The patients' friends, who notice a lack of mobility, are the first ones to draw their attention to the problem. Of the cardinal signs of the disease, bradykinesia is probably the most difficult to be detected early on^1,2. This lack of mobility, when affecting the upper limbs, may impair the functioning of self-winding wristwatches, which depend upon a periodic movement of the arm to keep working properly.

We report the case of a patient who bought a self-winding wristwatch, and after a short period of time began to notice a constant lateness when the watch was worn on the left arm. Neurological evaluation a couple of months later evidenced a parkinsonian syndrome.

CASE

A 63 years old male patient, born in Portugal but living in Brazil, states that his symptoms clearly began two years earlier, on a trip to Portugal. During this trip, he realized a life-long dream and bought a wristwatch of famous brand Rolex. After a short time, he noticed that it was constantly late. As no technical problem could be found, he switched to a battery watch, with no further problems.

A couple of months later, he sought medical attention with a complaint of slowness and lack of power in his left arm. A number of diagnostic procedures were performed, but no conclusion was arrived at.

When examined by a neurologist, he had a levodopa responsive parkinsonian syndrome: rest tremor, bradykinesia and rigidity, all of them predominantly on the left side. The Rolex is now functioning properly, on the right arm.

DISCUSSION

The diagnosis of a parkinsonian syndrome is achieved when at least two of the following symptoms are present : bradykinesia, rest tremor, rigidity and postural instability. One can also find, among others, a flexed posture and the freezing phenomenon. In order to establish the diagnosis of Parkinson's disease, an asymmetry of the symptoms as well as levodopa responsiveness are required^1-3.

An early diagnosis, although of paramount importance, is frequently difficult. Alternative diagnoses such as depression, osteoarthritis, painful shoulder and essential tremor, among others are not a rare occurrence in the first stages of the disease.

Detecting bradykinesia is a most difficult task, specially early on with no associated findings and confined to a single limb. Sometimes friends and family first notice this lack of mobility in the form of decreased motion of the arm or leg when walking^1,2.

A proposed way to detect early bradykinesia would be the functioning of self-winding wristwatches, which are dependent upon the periodic movements of the limb. In our patient, such a phenomenon occurred almost two years before the diagnosis was first suspected.

Andrade and Ferraz, in a 1996 publication⁴ discussed two patients with this initial manifestation, as well as a personal communication of the late Professor Marsden acknowledging some unreported cases of his own. The authors suggested the term Rolex sign⁴.

Recently, Mazzoni and Ford⁵ published a letter ("the freezing of time as a presenting symptom of Parkinson's disease"), describing a 68 years old patient who had a similar presentation, with the malfunctioning of a wristwatch when used over the affected arm. it should be noticed that in this patient, this phenomenon also occurred long before the diagnosis was established, presumably as a manifestation of early bradykinesia⁵.

Dr. Hélio Teive - Avenida Batel, 1230/108 - 80240-090 Curitiba PR - Brasil. Fax: [phone]. E-mail: [e-mail].

References

• 1. Marsden CD, Fahn S. Problems in Parkinson's disease and other akinetic rigid syndromes. In Marsden CD, Fahn S. Movement disorders 3. Oxford Butterworth Heinemann, 1994:117-123.
• 2. Weiner WJ, Lang AE. Parkinson's disease. In Weiner WJ, Lang AE. Movement disorders: a comprehensive survey. Mount Kisco, New York: Futura Publ 1989:23-115.
• 3. de Rijk MC, Tzourio C, Breteler MMB, et al.. Prevalence of parkinsonism and Parkinson's disease in Europe: the EUROPARKINSON Collaborative Study. J Neurol Neurosurg Psychiatry 1997;62:1-15.
• 4. Andrade LAF, Ferraz HB. Quadro clínico. In Meneses MS, Teive HAG. Doença de Parkinson: aspectos clínicos e cirúrgicos. Rio de Janeiro, Guanabara-Koogan, 1996:51-68.
• 5. Mazzoni P, Ford B. The freezing of time as a presenting symptom of Parkinson's disease (Letter). N Engl J Med 1999;341:1317-1318.

*

Associate Professor of Neurology - Federal University of Paraná;

**

Resident in Neurology - Federal University of Paraná. Aceite: 12-abril-200.

Publication Dates

• Publication in this collection
  06 Dec 2000
• Date of issue
  Sept 2000

History

• Accepted
  12 Apr 2000