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3 NERVOUS SYSTEM > BASAL GANGLIA & PARKINSONISM > Flashcards

BASAL GANGLIA & PARKINSONISM Flashcards

1
Q

Basal Ganglia is a MISNOMER

A

Basal Nuclei

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2
Q

Structural & Functional Components of BASAL GANGLIA

A
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3
Q

Parts of Substantia Nigra

A
  1. Pars Reticulata: Homologous to GP internus
  2. Pars Compacta
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4
Q

Wilson’s Pencil

A

Thin Myelinated (OR) Unmyelinated axons which are afferents & afferents passing through Straitum

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5
Q

⭐ Direct Pathway in Basal Ganglia does

⭐ Indirect Pathway in Basal Ganglia does

🧠⚡INdirect ⚡

A

⭐ Direct Pathway in Basal Ganglia does
🎯 Stimulates MOVEMENT

⭐ Indirect Pathway in Basal Ganglia does
🎯 INhibits MOVEMENT

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6
Q

Functions of BASAL GANGLIA

A

⭐ Inhibitory at REST ⭐

✨ TIMING & SCALING the intensity of movement
✨ Planning & Programming movement
✨ Cognitive component of Motor Activity
✨ Tone adjustment
✨ Movement Enhancer

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7
Q

2 EXTRA THINGS PRESENT in INDIRECT PATHWAY than DIRECT PATHWAY

A
  1. Globus pallidus Externus
  2. Subthalamus
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8
Q

Glutamate is EXCITATORY neurotransmitter, Released in BASAL GANGLIA by

A
  1. Cerebrum
  2. Subthalamus
  3. Thalamus
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9
Q

GABA is INHIBITORY neurotransmitter, Released in BASAL GANGLIA by

A

Corpus Straitum
✨ Caudate nucleus
✨ Putamen
✨ Globus pallidus

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10
Q

⭐ DOPAMINE is Released in BASAL GANGLIA

⭐ ACETYLCHOLINE is Released in BASAL GANGLIA

A

⭐ DOPAMINE is Released in BASAL GANGLIA
🎯 Substantia Nigra

⭐ ACETYLCHOLINE is Released in BASAL GANGLIA
🎯 Putamen

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11
Q

Direct pathway in BASAL GANGLIA

A
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12
Q

Indirect pathway in BASAL GANGLIA

A
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13
Q

Nigrostraital Pathway

A

Releases Dopamine
✨ D1 Receptor: Direct Pathway: Stimulate Movements

✨ D2 Receptor: Indirect Pathway: Inhibit Movements

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14
Q

Athetosis is DUE TO LESION in

A

Globus Pallidus

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15
Q

Athetosis

A

Slow
INVOLUNTARY
IRREGULAR
FORCEFUL
WRITHING movement
HANDS, ARM, NECK & FACE

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16
Q

Chorea is DUE TO LESION in

A

Caudate Nucleus
(OR)
Putamen

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17
Q

Chorea

A

Dancing like movement
Involuntary
Flicking movement
Hand, Face & Shouldera

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18
Q

Hemiballismus is DUE TO LESION in

A

Subthalamus
⬇️
Sudden Flailing movement of Entire limb

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19
Q

Parkinson’s disease is DUE TO LESION in

A

Substantia Nigra

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20
Q

Neurological Manifestation of WILSON DISEASE DUE TO

A

Copper Deposition in Lentiform nucleus

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21
Q

Only EXCITATORY NUCLEUS OF BASAL GANGLIA

A

Subthalamus

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22
Q

🚦DIFFERENTIAL DIAGNOSIS🚦 of HYPOKINETIC MOVEMENT

A
  1. Parkinson’s
  2. Non-Parkinson’s etiology
    ✨ Hypothyroidism
    ✨ Catatonia
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23
Q

⚡⚡ MOST COMMON NEURODEGENERATIVE DISEASE

⚡⚡ 2nd MOST COMMON NEURODEGENERATIVE DISEASE

⚡⚡ MOST COMMON SUBCORTICAL NEURODEGENERATIVE DISEASE

A

⚡⚡ MOST COMMON NEURODEGENERATIVE DISEASE
🎯 ALZHEIMER’S DISEASE

⚡⚡ 2nd MOST COMMON NEURODEGENERATIVE DISEASE
🎯 PARKINSON’S DISEASE

⚡⚡ MOST COMMON SUBCORTICAL NEURODEGENERATIVE DISEASE
🎯 PARKINSON’S DISEASE

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24
Q

Age of Parkinson’s presentation

A

≥ 65 yrs

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25
Q

If age of presentation of Parkinson’s DISEASE is ≤ 60yrs, known as

A

Familial Parkinson’s Disease

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26
Q

⚡⚡ MOST COMMON CAUSE of FAMILIAL PARKINSON’S
🧬 MODE OF INHERITENCE 💉

A

PARK8
⭐ AD
⭐ LRRK2 mutation

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27
Q

FAMILIAL Forms of PARKINSON’S

A
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28
Q

Function of Alpha Synuclein

A

Lipid Binding Protein ASSOCIATED with Synapses

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29
Q

Substantia Nigra is Pigmented DUE TO:

A

Presence of NEUROMELANIN Granules
⬇️
Synthesis of Dopamine

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30
Q

Lewy Body

A

Accumulation of Alpha Synuclein

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31
Q

Synuclein deposition occurs 1st in

A

Lower BRAINSTEM (MEDULLA)
⬇️
PONS
⬇️
MIDBRAIN
⬇️
SUBSTANTIA NIGRA

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32
Q

Prion like spread within Brain is ASSOCIATED with

A

PARKINSON’S DISEASE
✨ Alpha Synuclein aggregates can be released from 1 neuron & taken uup by another

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33
Q

Absent Swallow Tail Sign is seen in

A

MRI: PARKINSON’S DISEASE

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34
Q

MRI Signs of PARKINSON’S DISEASE

A
  1. Loss of Pigmentation in SUBSTANTIA NIGRA
  2. ABSENT SWALLOW TAIL SIGN
  3. B/L HYPERINTENSE GREY MATTER on upper Midbrain
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35
Q

Lewy Bodies can be seen in

A
  1. Other Pigmented nuclei in Brainstem
  2. Dorsal Nucleus of Vagus
  3. Nucleus BASALIS
  4. Other Cortical ASSOCIATION Areaa
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36
Q

Primary & Secondary PARKINSON’S Disease

🧠⚡2° causes: We Will Have DPT² ViaL⚡

A
  1. WILSON’s disease
  2. Whipple’s DISEASE
  3. Head Trauma: Dementia pugilistica
  4. Drug induced
  5. Post-encepahlitic
  6. Toxins: Manganese, MPTP, CO, Cyanide
  7. Tumour / Thyroid Function ⬇️ ⬇️
  8. Vascular
  9. Liver Failure
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37
Q

Symptoms of PARKINSON’S DISEASE
🧠⚡Be SMART⚡

A

ASYMMETRICAL
➕
1. Bending Forward (OR) Tilt
2. Shuffling Gait
3. Mask like facies
4. Akinesia / Bradykinesia
5. Rigidity
6. Tremors

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38
Q

Earliest Symptom of PARKINSON’S DISEASE

A

Tremor
⬇️
Akinesia
⬇️
Axial Skeleton: Gait & Posture
⬇️
Sleep, ANS, Sensory
⬇️
Cognitive Symptoms

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39
Q

Clinical Phenotypes of PARKINSON’S DISEASE

A
  1. Tremor Predominant
    🎯 Younger patient (60-70yrs)
    🎯 BETTER Prognosis
    🎯 SLOWER DISEASE PROGRESSION
  2. Akinetic Rigid Syndrome
    🎯 Older patient > 70yrs
    🎯 POOR Prognosis
    🎯 FASTER DISEASE PROGRESSION
40
Q

⚡⚡ MOST COMMON Clinical Phenotype of PARKINSON’S DISEASE

A

Tremor Predominant

41
Q

⚡⚡ MOST COMMON PRESENTING SYMPTOM OF PARKINSON’S DISEASE

42
Q

Charcteristic Features of TREMORS in PARKINSON’S DISEASE

A

✨ Pill Rolling Tremors

  1. Resting Tremor
  2. UL Distal
  3. Frequency: 5-6 Hz
  4. Asymmetrical: U/L ➡️➡️ B/L
  5. Worsens with Emotional Stress
  6. Disappears on VOLUNTARY ACTIVITY & SLEEP
  7. Brought ON by concentration
  8. Most patient t have Combination of Action ➕ Rest Tremors
43
Q

Types of TREMORS

A
  1. Resting Tremors
  2. Intentional tremors or Kinetic
  3. Postural
44
Q

Frequency of different types of TREMORS

🧠⚡REPs increasing⚡

A
  1. Resting Tremors in PD: 4-6Hz
  2. Essential Tremors: 8-10Hz
  3. Physiological Tremors: 12Hz
45
Q

Progression of Involvement of Limb in Tremors of PARKINSON’S DISEASE

A

I/L arm
⬇️
I/L Leg
⬇️
C/L Leg
⬇️
C/L Arm

46
Q

Difference between PD Tremor & Essential Tremors

47
Q

✨ Relieving Factors for PARKINSON’S DISEASE TREMOR

✨ Relieving Factors for ESSENTIAL TREMOR

A

✨ Relieving Factors for PARKINSON’S DISEASE TREMOR
🎯 L-DOPA
🎯 Dopamine agonists
🎯 anticholinergic

✨ Relieving Factors for ESSENTIAL TREMOR
🎯 ALCOHOL
🎯 PROPRANOLOL
🎯 PRIMIDONE
🎯 TOPIRAMATE
🎯 GABAPENTIN
🎯 CLONAZEPAM

48
Q

Target Site for DEEP BRAIN STIMULATION in:

⭐ PARKINSON’S DISEASE
⭐ DYSTONIA
⭐ DEPRESSION
⭐ OCD
⭐ ESSENTIAL TREMORS

A

⭐ PARKINSON’S DISEASE
🎯 SUBTHALAMUS
🎯 GPi

⭐ DYSTONIA
🎯 GPi

⭐ DEPRESSION
🎯 ANTERIOR LIMB OF INTERNAL CAPSULE
🎯 CINGULUM

⭐ OCD
🎯 ANTERIOR LIMB OF INTERNAL CAPSULE

⭐ ESSENTIAL TREMORS
🎯 VENTRAL INTERMEDIATE NUCLEUS

49
Q

Wheel Chair Sign seen in

A

PARKINSON’S DISEASE
✨ Rising from Wheel Chair: Difficult

50
Q

GLABELLAR TAP SIGN seen in

A

PARKINSON’S DISEASE

🎯 Repetitive Tapping (at 2Hz) over Glabella produces Sustained BLINK RESPONSE

51
Q

Myerson’s Sign

A

GLABELLAR TAP sigb

52
Q

Characteristic features of BRADYKINESIA in PARKINSON’S DISEASE

A
  1. Facial Hypomimia (Expressionless facies)
  2. Automatic Movements ⬇️⬇️ (Arm Swinging)
  3. Small Hand writing
  4. Wheel Chair Sign
  5. GLABELLAR TAP sign
  6. Difficulty in tying Shoelaces, buttoning up & Difficulty in ROLLING OVER in Bed
  7. Hypophonic Voice (Slow & Soft) Flat monotonus & stuttering
53
Q

⭐ Narrow Based Gait seen in
⭐ Broad Based Gait seen in

A

⭐ Narrow Based Gait seen in
🎯 PARKINSON’S DISEASE

⭐ Broad Based Gait seen in
🎯 PARKINSON Plus syndrome
💎 Cerebellar disease

54
Q

Abnormal Pull Test seen in

A

PARKINSON’S DISEASE
⬇️
Pt falls backward

55
Q

Froment’s sign seen in
⭐ Meaning

A

PARKINSON’S DISEASE

⭐ Activity induced ⬆️ in C/L Limb Rigidity

56
Q

Rigidity vs Spasticity

57
Q

Difference BETWEEN PARKINSON’S DISEASE DEMENTIA & LEWY BODY DEMENTIA

58
Q

PARKINSON PLUS ➕ SYNDROME

🧠⚡PCM Do⚡

A

Group of disorder that presents with PARKINSONISM Features (BRADYKINESIA & RIGIDITY) but are different in underlying clinical manifestations & pathology

  1. Progressive Supranuclear Palsy
  2. Cortico-basal Degeneration
  3. Multi-system Atrophy
  4. Diffuse Lewy Body DEMENTIA
59
Q

Steele Richardson Olszewski Syndrome

A

Progressive Supranuclear Palsy

60
Q

Suspect PARKINSON plus syndrome if

A
  1. No response to Levodopa
  2. Absense of Rest Tremors
  3. Severe & Early ANS features
  4. Cortical abnormality: Apraxia
  5. Supranuclear gaze palsy
  6. Predominant Cerebellar (OR) Pyramidal findings
  7. Early ONSET REPEATED FALLS
  8. Symmetrical BRADYKINESIA
  9. EARLY DEMENTIA & HALLUCINATION
61
Q

UK BRAIN BANK CRITERIA is used to diagnose

A

Parkinson’s disease

62
Q

Synucleinopathies

🧠⚡P²REM = Love⚡

A
  1. Parkinson’s disease
  2. Pure Autonomic Failure
  3. REM Behavioural Disorders
  4. Multi system atrophy
  5. Lewy Body DEMENTIA
63
Q

In PARKINSON’S & LEWY BODY DEMENTIA, Synuclein aggregates in

In MULTI SYSTEM ATROPHY, Synuclein aggregates in

A

In PARKINSON’S & LEWY BODY DEMENTIA, Synuclein aggregates in
🎯 Neurons

In MULTI SYSTEM ATROPHY, Synuclein aggregates in
🎯 Glial Cells

64
Q

⭐ Hyper-phosphorylated Tau Proteins are aggregated in

⭐ Hypo-phosphorylated Tau Proteins are aggregated in

A

⭐ Hyper-phosphorylated Tau Proteins are aggregated in
🎯 ALZHEIMER’S DISEASE

⭐ Hypo-phosphorylated Tau Proteins are aggregated in
🎯 PICK’S DISEASE

65
Q

SUBCORTICAL TAUPATHIES

A
  1. Progressive Supranuclear Palsy
  2. Corticobulbr Degeneration
66
Q

TAUPATHIES

🧠⚡PNS C And D⚡

A
  1. Progressive Supranuclear Palsy
  2. Pick’s disease
  3. Post-encephalitic PARKINSON’S DISEASE
  4. Pantothenate Kinase ASSOCIATED Degeneration
  5. Niemann Pick DISEASE type C
  6. SSPE
  7. CBD
  8. Chronic Traumatic Encephalopathy (Dementia Pugilistica)
  9. ALZHEIMER’S disease
  10. Down’s Syndrome
67
Q

🌸 TYPES of MSA Multi System Atrophy

🧠⚡ PAC⚡

A
  1. MSA-P: PARKINSON like presentation
  2. MSA-A: Autonomic Features Predominant
  3. MSA-C: Cerebellar Features Predominant
68
Q

Shy Dagger Syndrome

69
Q

SHY DAGGER SYNDROME
🧠⚡SHY? Parked Cerebellum⚡

A
  1. Systemic Atrophy
  2. Hypotension
  3. Y = Urinary Incontinence / Urgency ➕ other autonomic features
  4. Symptoms of PARKINSON’S DISEASE
  5. Cerebellum problems: Coordination & Speech
70
Q

LEWY Body DEMENTIA
🧠⚡
Lewyhas halLEWYcinations.
Lewy is slowy.
Lewy is sleepy.
Lewy is slippy.
lEwy also has an E
⚡
🧠⚡ Lewy is slow-y, sleepy, slippy and sees things (halLEWYcinations)⚡

A

✨ Visual hallucinations are common
✨ Slow movements for Parkinson’s disease
✨ REM sleep abnormalities like drowsiness.
✨ DLB is associated with frequent falls.
✨ eosinophilic intracytoplasmic alpha synuclein aggregates.

71
Q

Essential TREMORS

A

More common in males

Family history often present

It’s an action tremor (not resting)

Tremor begins in hands>arms>head»legs (very rarely are legs involved)

Rx: 1) Non-selective beta-blocker (Propranolol)
2) Primidone (anticonvulsant)

Alcohol improves the symptoms.

72
Q

🧑🏻‍⚕️ Clinical Features of MSA

A
  1. Cranio-cervical dystonia
  2. High Pitched Dysarthria
  3. Pyramidal involvement ➕
  4. Autonomic features ➕
  5. Cerebellar features ➕
73
Q

Radiological findings of MSA

A

IN MSA-C
1. Cruciform Hyperintensity @ Pons
2. Hot cross Bun sign

in MSA-P
3. PUtamen Ring Hyperintensity

74
Q

PSP
🧠⚡BEEF HAFS⚡

A
  1. Broad Based Gait
  2. Extension Hypertonia: Retrocollis
  3. Eyelid Apraxia: Down Gaze Palsy
  4. Emotional Incontinence
  5. Frequent Falls
  6. Facial Dystonia: Procerus (OR) Surprise sign
  7. Hummingbird (OR) Penguin Sign on MRI
  8. Applause Sign ➕
  9. Frontal Release Sign ➕
  10. Spastic Dysarthria
75
Q

PARKINSON plus syndrome with EARLY FREQUENT FALLS

76
Q

Flexion Hypertonia seen in

Extension Hypertonia seen in

A

Flexion Hypertonia seen in
🎯 PARKINSON’S DISEASE

Extension Hypertonia seen in
🎯 PROGRESSIVE Supranuclear PALSY

77
Q

Procerus sign (OR) Surprise sign seen in

A

Progressive Supranuclear Palsy

78
Q

Applause sign

⭐ Seen in

A

When you ask to applause, the patient don’t STOP, NORMAL person stops

⭐ Seen in: Progressive Supranuclear Palsy

79
Q

How to differentiate BETWEEN Progressive Supranuclear Palsy & Pick’s Disease

A

Applause test ➕ in PSP

80
Q

Cause of development of HUMMINGBIRD SIGN on MRI

A

Atrophy of MID-BRAIN

81
Q

Dysarthria: TYPES

A
  1. FLACCID
  2. SPASTIC
  3. CEREBELLAR
82
Q

Difference BETWEEN PSP & CBD on H&E

A

CBD: Tufted ASTROCYTES
CBD: ASTROCYTE PLAQUES

83
Q

PARKINSONISM Motor Features
➕
CORTICAL Features ➕
➕
MRI: CORTICAL ATROPHY

A

Corticobasal Degeneration

84
Q

🧑🏻‍⚕️ Clinical Features of CORTICOBASAL DEGENERATION

A
  1. Apraxia, Agnosia
  2. Alien Limb Phenomena
  3. Asymmetrical DYSTONIC Contractions
  4. Dystonia
85
Q

Alien Limb Phenomena seen in
⭐meaning

A

CORTICOBASAL DEGENERATION

⭐ Without own’s knowledge, limb assumes a position in space
⬇️
Doing something, you don’t know about

86
Q

Neuroprotective Drugs used in PARKINSON’S DISEASE

A
  1. MAO-B ⛔
    ✨ Selegeline
  2. Glutamate antagonist
    ✨ Riluzole
87
Q

Drugs causing PARKINSONISM

🧠⚡ NA FART⚡

A
  1. Neuroleptics
  2. Amiodarone
  3. Flunarizine
  4. Alpha Methyl DOPA
  5. Reserpine
  6. Tetrabenazine
  7. Metoclopramide
  8. Lithium
  9. Cinnarizine
88
Q

Treatment of PARKINSON’S DISEASE
🧠⚡ Cold SALAD⚡

89
Q

Symptoms of PARKINSON’S that do NOT IMPROVE with Levodopa
🧠⚡CAP Falls ⚡

A
  1. Cognitive impairment: DEMENTIA ➕ Sleep d/o
  2. ANS Symptoms
  3. Postural instability
  4. Falls
90
Q

Levodopa benefits which symptoms

🧠⚡TRAp ⚡

A
  1. Tremors
  2. Rigidity
  3. BRADYKINESIA (OR) Akinesia
91
Q

🤢😳SIDE EFFECTS🥴😵 of LEVODOPA

92
Q

Peak Dose Dyskinesia with LEVODOPA

A

Choreiform movement, Athetosis & Ballismus

  1. Young ♀️ with Severe Disease
  2. With HIGHER Dose of Levodopa
  3. Rhythmic contractions Predominant in Lower Limb
93
Q

Wearing Off Phenomena

94
Q

On Off Phenomena seen with

A

Levodopa
⬇️
Unpredictable fluctuations
✨ ON: Dyskinesia ➕
✨ OFF: Dystonia

95
Q

PISA SYNDROME seen in

A

Seen in PARKINSON’S DISEASE pt treated with LEVODOPA
✨ In OFF Phase

3 NERVOUS SYSTEM (40 decks)

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