neurodegenerative Flashcards
whats the main criteria for PD
bradykinesia-you must have
how would you test Parkinson’s clinically
Bradykinesia
1. asking them to perform movements like thmb to indiex, open fist close fist, toe tap ,
tell them to get them as FAST and as high as you can to notice the difference
- glabellar
- Gait - walking
small shuffles, loss of arm swing , leaning forward, hunche,they have difficulty initiating movement
pull test - correcting themselves in 1/ 2 movements
- standing up from a chair without using arms as support, cross arms to chest
- Tone for rigidly ( remember if taking meds, it could mask it)
so you can do activation manouveres ]passve mmovement of neck - tremors
usually starts on one side and then as it progrisively to other side
most common is resting tremor
can notice it by asking patient to outstretch arms in front of them with fingers spread wide
finger to nose (this is not ataxia so doesnt have to be as as fast and you can keep your finger in place and not move it in space, must be slow enough to observe the tremor if too fast you can miss it
pneumonic for PD
TRAP
tremor
rigidity
akinesia
postural hypotension
prayer sign
fingers wont be able to be striaght due to flexion contrcatures
L’hermitte sign
seen in MS when you flex the neck
painful for some and other just feels like elctic shocks, spread down neck to spine and sometimes arms /legs
tx OF MS FLAR
cs
definitive diagnose fo MS
oligo clonal bands in csf (antibodies)
white matter lesions in MRI
mcdonals criteria is for
MS
optic neuritis def and whats it associated with and symtptom s
- inflammtion of the optic nerve
- MS
- pain with moving the eye, vision loss , usually affects 1 eye
symptoms of MS
- optic neuriits
- internuclear opthalmoplegia
- autonmc dysfunction
- lhermite
- spastic. hyperfexia
- sensory loss
- paraethsia
does MS AFFECT SENSATION
YES
DEF MS
autoimmune disease affecting the CNS, causing demylinaiton and inflammation
if vibration is reduces what is affected
dorsal columns
types of MS
- RELAPSE AND REMITTINE
- PRIMARY PROGRESSIVE
neuro exam MS
- check power
- check clonus
- cerebellar tests - heel to shin
- reflexes - should be brisk
pathological reflexes - babinksi
5.propioception - sensation - pin prcik
paraperesis meaning
weakenss of both legs
pes cavus causes
high arched foot
- traume
- neruo - charco marie tooth/friedrichs ataxia
which tests crude touch
spinothalmic
features of parkinosns
TRAP
autonomic dysfucntion- constipation, hypotension, erectile dysfunction, bladder and bowel
psychiatric disturbance
micrographia
hypomimia
olfactory smell - the olfactory bulb can. get demaged
SLEEP disturbances - dopamine involved in sleep
difference between spasticity and rigidity
both present an increase in ton
spasticity - velocity dependant rhe faster you go the more resistance you feel
spasticity usuallya assoc with pyramindal tract
rigidity - not velocity dependent
assoc with basal ganglia
en bloc turning
difficulty turning direction? assoc with PD
dopamine related disordrs
- PD
- SCHIZOPHRENIA
- ADHD
whats an important thing to remember about parkinosns disease
many times the motor symptoms are. a late sign and things such as constipation, anosmia come first - NB !
effects of dopamine
- Affects your mood
- involved in sleep
3.involved in gut motility - reward and pleasure
5.involved in movement ! (hence parkinsons)
parkinsonism
basically features of parkinson but not caused by loss of neurons. like drugs
is there a link between PD AND DEMENTIA
yes,
people with PD can develop parkinonian dementia as it spreads to other regions of the brain
diagnosis of pD
clinical
and response to symptoms after starting levodopa
MRI - head
tx of parkinson’s
DOPAMINE AGONISTS levodopa
Often combined with carbidopa - to decrease side effects Co-careldopa.
as time goes on levodopa becomes less effective
side effects of antiparkinon drugs
tardive dyskinesia
naseua and vom- hence why these pt are on antiemetic
orthostatic - can be the disease itself or a side effect
day time sleepiness or sudden onset sleepe
what can we give for orthostatic hypo in pd
fludricortisone- conserves na +
midrodine- vasopressor ftr
the tremor in pd is usally
unilateral
myasthenic crisis
an acute worsening of the disease so severe weakness of respiratory muscles/diaphragm
