Neurological disorders Flashcards
What is Parkinson’s disease?
Long term degenerative disorder of the central nervous system. Mainly affects the motor system.
What’s the trio of Parkinson’s symptoms?
Pill rolling tremor at rest
Cog-wheel rigidity
Bradykinesia
Symptoms of Parkinson’s?
Rigidity (cog wheel, lead pipe) Pill rolling tremor Bradykinesia - micrography - monotonous voice - blank facial expression
Stooped posture Sleep disorders Depression Dementia Psychosis: visual hallucinations Postural hypotension Shuffling gait
Which drugs can induce parkinsonism?
Typical anti-psychotics
Metoclopramide (anti-emetic)
Dopamine receptor antagonists, so less dopamine able to bind to receptors to pass nerve impulses along
Diagnosis of Parkinson’s?
Clinical
DAT Scan
Management of Parkinson’s?
Drugs:
Levo-dopa
Dopamine agonist ropinerol
Dopamine deoxycarbylase inhibitor - carbidopa
MAO B inhibitor - selegeline
Postural physiotherapy
Screen for depression
Deep brain stimulation
Side effects of Levo-dopa?
Gambling, loss of inhibitions Psychosis Dry mouth Daytime sleepiness Insomnia N + V
Differential diagnosis of Parksinson’s features?
Parkinson’s disease
Drug induced: typical anti-psychotic, metoclopramide
Wilson’s disease
Infection: HIV, syphilis, CJD
Lewy body dementia
Multiple infarcts in substantia nigra
Pathophysiology of Parkinson’s?
Histopathology
Pars compacta of substantia nigra
Destruction of dopaminergic neurons in pars compacta of substantia nigra
Because of:
B amyloid plaques
Lewy bodies
Neurofibrillary tangles
3 signs in acute dystonia?
In what situations do these occur?
Torticolis: abnormal head/neck posture
Oculogyric crisis: eyes roll into back of head
Trismus: lockjaw, cant open properly
After use of typical anti-psychotics
Give some examination findings of Parkinson’s?
Cog wheel rigidity hypertonia Pill rolling tremor Shuffling gait Bradykinesia Postural instability
Describe the writing of a Parkinson’s patient?
Micrographia
That tails off
What are some Parkinson’s plus diseases?
Lewy body dementia
Multiple system atrophy
What investigation would you do for a patient with ataxia, urinary incontinence and dementia?
To rule out what specifically?
Head CT
To rule out normal pressure hydrocephalus
What are the three main features of normal pressure hydrocephalus?
Ataxia
Incontinence
Dementia
What is normal pressure hydrocephalus?
Chronic dilation of the lateral cerebral ventricles and distortion of the fibres in the corona radiata
CSF pressure is normal
Management of normal pressure hydrocephalus?
Shunt from the ventricles to the peritoneal cavity
What is multiple system atrophy?
Damage to nerve cells in the CNS
Causing dysfunction
Parkinsonism
Autonomic dysfunction
Differentiate Lewy body from other dementias?
DAT scan
Differentiate fronto-temporal from other dementias?
SPECT scan
Essential tremor, clinical features?
Bilateral upper limb
Initially transient then persistent
Can involve head, jaw
Improved by alcohol and concentrating on task
Management of essential tremor?
Propanolol
Primidone
Gabapentin
Deep brain stimulation
Trigeminal neuralgia, clinical features?
What triggers it?
Paraesthesia prodrome
Then sharp ipsilateral pain affecting cheek, eyes, lips, scalp!
Triggered by vibration, skin contact (e.g. shaving), brushing teeth, eating, drinking, the wind
Pathophysiology of trigeminal neuralgia?
Compression (by blood vessels), demyelination (MS), degeneration
Which branches of trigeminal nerve are affected in trigeminal neuralgia?
Maxillary
Mandibular
Investigations and management of trigeminal neuralgia?
MRI
Carbamazepine
Gabapentin
Surgery
What would you see on a CT head in Parkinson’s
Nothing
Normal
