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Neurology > 2: Movement Disorders - Parkinsons Disease > Flashcards

2: Movement Disorders - Parkinsons Disease Flashcards

1
Q

Define Parkinsonism

A

Syndrome caused by extra-pyramidal triad of tremor, hypertonia and bradykinesia

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2
Q

Define Parkinson’s Disease

A

Disease caused by degeneration of dopaminergic neurons in substantia nigra

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3
Q

Explain prevalence of parkinson’s disease with age

A

Increases

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4
Q

Which gender is PD more common

A

Male

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5
Q

What can cause Parkinsonism

A
  • Wilson’s disease
  • Anti-dopaminergic medications (Antipsychotics, Metclopramide)
  • MTTP
  • Post-encephalitis
  • Dementia Puglistica
  • CO poisoning
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6
Q

What is dementia pugilistica

A

Dementia caused by repetitive head trauma

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7
Q

What causes Parkinson’s disease

A

Idiopathic

Genetic (PINK1)

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8
Q

What are 4 risk factors for Parkinson’s disease

A
  • FH
  • Pesticide exposure
  • Genetics (LRRK2)
  • Diet - vitamin D Deficiency
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9
Q

If PD unilateral or bilateral symptoms

A

Unilateral

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10
Q

What is the triad of symptoms on PD

A
  • Tremor
  • Bradykinesia
  • Rigidity
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11
Q

Explain bradykinesia in PD

A
  • Difficultly initiating movement
  • Movements are slow and decrease with amplitude with repetitive movement = micrographia
  • Shuffling gait, stops when reaches objects
  • Expressionless face
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12
Q

What tremor is present in PD

A

Pill-rolling tremor, present at rest

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13
Q

When is tremor worse in PD

A

Worse at rest. Exacerbated when stressed or tired

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14
Q

What are the two types of rigidity in PD

A

Lead-pipe

Cog wheel

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15
Q

What is lead-pipe rigidity

A

No tremor present

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16
Q

What is cog-wheel rigidity

A

Mix of hypertonia and tremor

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17
Q

What are 5 other symptoms of PD

A
  • Drooling
  • Unhabituated glabella reflex
  • Psychiatric disturbance
  • REM sleep disorder
  • Postural hypotension
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18
Q

What psychiatric features are common in PD

A

Depression (40%)

Psychosis

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19
Q

When does REM sleep disorder occur in PD

A

Before motor symptoms

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20
Q

When does impaired olfaction occur in PD

A

Before motor symptoms

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21
Q

Why does postural hypotension occur in PD

A

Autonomic dysfunction

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22
Q

What are Parkinson plus syndromes

A

Syndromes that occur with Parkinsonism

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23
Q

What are the 4 Parkinson plus syndromes

A
  • Multiple System atrophy
  • Lewy body dementia
  • Progressive supra nuclear palsy
  • Cortical-Basal degeneration
24
Q

What is multiple system atrophy also referred to as

A

Shy Drager

25
Q

Explain presentation of multiple system atrophy

A

Presents with:

  • Early autonomic symptoms
  • Cerebellar signs
  • Parkinsonism
26
Q

What are 3 symptoms of early autonomic involvement

A

Erectile Dysfunction
Postural hypotension
Bladder atony

27
Q

What is the mnemonic to remember cerebellar signs

A

DANISH

28
Q

What are cerebellar signs

A

DDK

Ataxia

Nystagmus

Intention tremor

Slurred/Stacato speech

Hypotonia

29
Q

What imaging is ordered in MSA

A

MRI

30
Q

What sign on MRI is pathognomic of MSA

A

Hot-Cross Bun Sign

31
Q

What is progressive supra nuclear palsy also called as

A

Steele-Richardson-Olszewki Syndrome

32
Q

What are symptoms of Progressive Supranuclear Palsy

A
  • Impaired vertical gaze. Downward gaze is worse than upward
  • Dolls eye reflex is preserved
  • Parkinsonism
  • Trunk rigidity
  • Slurred speech
33
Q

What may patients with PSP struggle with

A

Reading

Walking down stairs

34
Q

What is dolls-eye reflex

A

Eyes remain still when head moves

35
Q

What imaging is ordered in PSP

A

MRI

36
Q

What sign is pathognomic of PSP

A

Humming bird sign

37
Q

What is problem,w with managing PSP

A

Poor response to L-Dopa

38
Q

What is classic presentation of cortic-basal degeneration

A

Akathisia of a limb = causing alien limb syndrome
Dementia
Apraxia
Cortical sensory loss

39
Q

Explain presentation of drug-induced parkinsonism compared to PD

A

Bilateral
Quicker onset of symptoms
Rigidity and tremor are rare

40
Q

What is offered to treat PD

A

Levo-dopa and dopa decarboxylase inhibitor

41
Q

When is levodopa and peripheral dopa decarboxylase inhibitor offered

A

If symptoms are impacting a patient’s QOL

42
Q

What may be given with Levodopa to improve compliance

A

COMT inhibitor

43
Q

What is second-line in PD

A

Monoamine Oxidase Inhibitor

44
Q

Name a monoamine oxidase inhibitor

A

Selegiline

45
Q

When are MAOI indicated

A

If symptoms are not impacting patient’s QOL

46
Q

What is third-line for PD

A

Dopamine agonist

47
Q

Name a dopamine agonist

A

Pramiprexole, Ropinirole

48
Q

When are dopamine agonists preferred

A

Younger patients

49
Q

What is offered for dyskinesia in PD

A

Amantidine

50
Q

What is the MOA of amantaidine

A

NMDA antagonist

51
Q

What surgical treatment can be used in PD

A

DBS of sub thalamic nucleus

52
Q

When is deep brain stimulation of sub thalamic nucleus indicated in PD

A

Advanced Parkinson’s disease refractory to medical treatment

53
Q

What drug is given for postural hypotension in PD

A

Midodrine

54
Q

What is the MOA of midrodrine

A

Acts on peripheral a-receptors to increase vascular resistance

55
Q

What is used to manage drooling in PD

A

Glycopyronium bromide

Neurology (26 decks)

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