neurology

Question 1

what is the pathophysiology of parkinson’s disease?

Answer 1

loss of dopamine neurons in the substantia nigra (part of the basal ganglia) –> leading to increased inhibitory effect on the cortex –> causing decreased movements

Question 2

what are the cardinal features of parkinson’s disease?

Answer 2

bradykinesia (most important)
pill rolling tremor
postural instability
rigidity - cogwheeling

Question 3

how is parkinson’s disease diagnosed?

Answer 3

clinical diagnosis based on:

• presence of bradykinesia + one of the other cardinal manifestations
• excellent response to levadopa treatment
• unilateral onset with persistent asymmetry throughout progression of disease with the side of onset most affected

Question 4

differential diagnoses to consider with parkinson’s disease?

Answer 4

essential tremor - intentional tremor
DLB - dementia will precede parkisonism or concomittantly, asosciated w/ visual hallucinations
corticobasal degeneration - loss of cortical sensory function
progressive supranuclear palsy - vertical supranuclear palsy + symmetrical bradykinesia and rigidity + pseudobulbar palsy

Question 5

first line pharmacological treatment of parkinson’s disease?

Answer 5

first line treatment: levadopa/carbidopa or non ergot dopamine agonist (pramipexole, ropinirole) for younger patients

*classic dosage is starting on levadopa 100mg/carbidopa 25mg

Question 6

what are the anti-emetics that can be used in in parkison’s disease?

Answer 6

domperidone

ondanestron

Question 7

what are the side effects of ergot dopamine agonist (bromocriptine, cabergoline)?

Answer 7

cardiac valvular damage, retroperitoneal effusion, pleural effusion, vasospasm

Question 8

what are common side effects of levadopa treatment?

Answer 8

nausea
vomiting
postural hypotension