The Italian NMSS is a comprehensive and helpful measure for NMS in native Italian patients with PD.

A multicenter study has been conducted to determine the interobserver reproducibility of four of the most frequently used rating scales for Parkinson's disease: the Columbia University Rating Scale (CURS) and the Webster Rating Scale (WRS), both for assessing clinical signs; the Northwestern University Disability Scale (NUDS); and the Hoehn and Yahr staging. Four resident neurologists, inexperienced in the use of the four scales, independently examined 48 parkinsonian patients. The extent to which their assessments agreed was determined by calculating the Cohen k index after the scores had been recodified. The physicians' scores agreed substantially for the CURS and the Hoehn and Yahr scale, while those for the NUDS and the WRS agreed only moderately. Analysis of individual item scores within the scales suggests improvements that would offer greater interobserver consistency.

SUMMARY Progressive Parkinsonism, dystonia and apraxia of eye opening were seen after cyanide poisoning. CT scan and MRI showed lesions in the basal ganglia, cerebellum and cerebral cortex consistent with reported pathological findings.Parkinsonian signs and abnormal postures after cyanide poisoning have been described.' 2 Since cyanide poisoning is almost always fatal, reports of patients surviving to develop neurological signs are few. We report here the clinical and radiological features of one patient who developed Parkinsonism, dystonia and a disorder of eye opening following accidental cyanide poisoning.Case report A 46 year old woman and her husband were brought to the hospital after drinking from a bottle of a soft drink which had been adulterated with cyanide. The man died before arriving at the hospital. On admission, his wife was found to be in light coma, readily reacting to pain and moving her limbs without obvious asymmetry. Babinski's sign was present on the right. An analysis of gastric aspirates from the patient and her husband confirmed the presence of cyanide. CT scan and cerebrospinal fluid examination were normal.EEG showed marked diffuse slow activity, but was normal on discharge. The patient showed occasional decerebrate posturing, but slowly recovered in 2 weeks. She was transferred to a rehabilitation unit where she was found to have dysphonia and dysarthria, slight plastic limb hypertonia, slight right hemiparesis with right Babinski's sign and diffuse hyperactivity of tendon reflexes.One year later, the patient was admitted to another hospital because of increasing speech and swallowing difficulties, drooling and unsteadiness of gait. CT scan showed only moderate cortical atrophy; EEG showed minor Address for reprint requests:

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