Neurology Flashcards
Dementia comes 1 year post diagnosis of Parkinsons
Parkinson’s dementia
Signs of dementia occurs first before parkinsonism
Lewy Body Dementia
Parkinsons Triad?
Brady/Hypokinesia
Pin-rolling tremor worse at rest
Increased tone leading to lead-pipe rigidity
Other symptoms of Parkinsons
Autonomic dysfunction - postural hypotension
Psychiatric - depression/dementia/visual hallucinations
Sensory: Anosmia, augesia
What are examples of brady/hypokinesia in Parkinsons?
Shuffling gait. No arm swing. Hypomimia. Micrographia. Stopping at obstacles. Slurred speech.
How is the Parkinson’s diagnosis made usually?
Clinical diagnosis from bradykinesia and either tremor or rigidity.
Is the tremor from Parkinson’s worse or better at rest?
Worse at rest and improves with voluntary movement.
What drugs can cause parkinsonism?
Anti-psychotics and metoclopramide
What anti-emetic can you use in parkinsons? and what cant you use?
cant use metoclopramide
can use domperidone.
What are features of Lewy Body Dementia?
Timing wise?
What goes?
Dementia first, then parkinsonism.
Progressive nature.
Visual hallucination.
Inattention + executive functioning before memory.
What medication can you use to treat LBD?
Memantine and acetylcholinesterase inhibitors (donepezil, rivastigmine)
why cant you give antipsychotics in LBD?
worsens parkinsonism
what drug do you give w levodopa and why?
decarboxylase inhibitor (carbidopa or benserizide) to prevent peripheral breakdown of levodopa into dopamine
What is the features of progressive supranuclear palsy?
Vertical gaze is impaired (downward gaze worse than upward so hard to read and go down stairs) Parkinsonism Falls slurring of speech cognitive impairment
Progressive supranuclear palsy responds to levodopa?
No, PSP has poor response to levodopa.
Side effects of metoclopramide:
Parkinsonism
extrapyramidal side effects - oculogyric crisis
Tardive dyskinesia
hyperprolactinaemia
What are the Parkinson plus syndromes?
Lewy body dementia, progressive supranuclear palsy,
multiple system atrophy
What are the features of multiple system atrophy?
Parkinsonism & cerebellar
Autonomic dysfunction: erectile dysfunction, postural hypotension, atonic bladder
After a patient started taking anti-psychotics, (hours - days) she started developing fever/pyrexia, muscle rigidity and is agi + confused.
Blood pressure raised, breathing rate raised, pulse rate raised.
what the heck is going on?
Neuroleptic Malignant Syndrome caused by the anti-psychotics.
In neuroleptic malignant syndrome, what would you see in blood investigations?
think FBC and renal
Leukocytosis
Creatine Kinase raised
What meds do you give for severe neuroleptic syndrome?
Dantrolene
