Basal Ganglia Disorders

Question 0

What are the features of Parkinsonian syndrome

Answer 0

Rigidity
Bradykinesia
Resting tremor

Question 1

Name 3 problems caused by basal ganglia pathology

Answer 1

Parkinsonian syndrome
Dystonia
Chorea

Question 2

What are the features of dystonia?

Answer 2

Prolonged muscle spasms and abnormal posture

Question 3

What are the features of chorea?

Answer 3

Jerky out of control movements

Called ballismus if large

Question 4

Describe the pathology of Parkinson’s disease

Answer 4

Sections of brainstem reveals loss of dark pigment in substantia Nigeria and locus coeruleus
Pigment loss correlates with dopaminergic cell loss
Levy bodies

Question 5

What are the motor symptoms of Parkinson’s disease

Answer 5

Bradykinesia
Rest tremor
Rigidity
Postural and gait impairment

Question 6

What are the features of Parkinson’s bradykinesia

Answer 6

Slowness of movement with progressive loss of amplitude and speed
Hypomimia- decreased facial expression
Hypophonia
Micrographia- progressively smaller hand writing

Question 7

What are the features of the resting tremor in Parkinson’s

Answer 7

Vanishes with active movement
Reappears with a few seconds of arms held outstretched
Pill rolling, finger flexion-extension or abduction-adduction
Head tremor not common

Question 8

What are the features of rigidity in Parkinson’s

Answer 8

Increased muscle tone felt during passive movement
No increase with higher mobilising speed
Cog wheel rigidity at wrist
Positive Froments manoeuvre- rigidity increases when other body parts move

Question 9

What are the features of postural and gait impairment in Parkinson’s

Answer 9

Stooped posture
Anterior truncal flexion
Slow shuffling gait
Slow turning with multiple small steps
Freezing

Question 10

What are the non motor features of Parkinson’s

Answer 10

Hyposmia
REM
Constipation
Depression
Dementia
Hallucinations

Question 11

What investigations are used in suspected Parkinson’s?

Answer 11

Structural brain imaging
Dopamine functional imaging- PET with fluoro-dopa
Dopamine transporter imaging with single photon emission CT

Question 12

Parkinson’s disease red flags (select 5)

Answer 12

Absence of asymmetry of symptoms
Severe axial or lower limb involvement
Frequent falls
Fast disease progression
Eye movement disorder
Other movement disorders
Pyramidal or cerebellar dysfunction
Bulbar or pseudobulbar features
Parietal associative sensory disturbances
Apraxia
Severe cognitive deterioration or psychosis
Marked autonomic dysfunction
Negative levodopa challenge

Question 13

Common causes of Parkinsonism - name 5

Answer 13

Parkinson's disease
Drug induced- prochlorperazine, metoclopromide, antipsychotics
Progressive supranuclear palsy
Multiple system atrophy
Dementia with Lewy bodies
Diffuse white matter ischaemia

Question 14

What drugs are used to treat the motor symptoms of Parkinson’s disease?

Answer 14

Levodopa with a peripheral decarboxylase inhibitor (benserazide, carbidopa)
Dopamine agonists (bromocriptine, pergolide, ropinirole)
Catechol-O-methyltransferase inhibitor (entacapone, tolcapone)
Amantadine