Parkinson Disease Flashcards

1
Q

Cardinal Features of PD

A

Rest tremor
Rigidity
Bradykinesia
Gait impairment

Additional features
Freezing of gait
Postural instability
Speech difficulty
Autonomic disturbances
Sensory alterations
Mood disorders
Sleep dysfunction
Cognitive impairment
Dementia
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2
Q

Pathologic hallmark of PD

A
  1. Degeneration of dopaminergic neurons in the substantia nigra pars compacta
  2. Reduced striatal dopamine
  3. Intracytoplasmic proteinaceous inclusions known as Lewy bodies that primarily contain alpha synuclein
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3
Q

Parts of the Basal Ganglia

A

Striatum (putamen and caudate nucleus)
Subthalamic nucleus
Globus pallidus (interna and externa)
Substantia nigra pars compacta

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4
Q

Gene mutation that is most common cause in familial PD

A

LRRK2 Gene
Commonly seen in Ashkenazi Jew and North African Berber Arabs

Mutations in Parkin Gene should be considered in patients with onset prior to 40 yo

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5
Q

Multiple System Atrophy manifests as a combination of :

A

(1) Parkinsonian
(2) Cerebellar
(3) Autonomic Features

Divided into:

(1) predominant parkinsonian
(2) predominant cerebellar

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6
Q

Pathologic characteristics of MSA

A

Degeneration of SNc, striatum, cerebellum, and inferior olivary nucleus coupled with characteristic glial cytoplasmic inclusions that stain for alpha-synuclein

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7
Q

MRI pathology for MSA

A

Pathologic iron accumulation in the striatum on T2 weighted scans,

high signal change in the region of the external surface of the putamen (putaminal rim) in MSA-p,

or cerebellar and brain stem atrophy (pontine “hot cross buns” sign in MSA-c

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8
Q

Form of atypical parkinsonism characterised by

Slow ocular saccades
Eyelid apraxia
Restricted eye movements with particular impairment of downard gaze

A

Progressive supranuclear palsy

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9
Q

MRI pathology in progressive supranuclear palsy

A

Atrophy of the midbrain with relative preservation of the pons,
“The hummingbird sign” on midsagittal images

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10
Q

Characteristic pathology of PSP

A

Degeneration of the SNc, striatum, subthalamic nucleus, midline thalamic nuclei and pallidum along with neurofibrillary tangles and inclusions that stain for the tau protein

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11
Q

Manifests as asymmetric dystonic contractions and clumsiness of one hand coupled with cortical sensory disturbances (apraxia, agnosia, focal limb myoclonus or alien limb phenomenon)

A

Corticobasal ganglionic degeneration

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12
Q

Causes of secondary parkinsonism

A
Drugs
Stroke
Tumor
Infection
Exposure to toxins e.g. Carbon monoxide and manganese
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13
Q

Most common cause of secondary parkinsonism

A

Dopamine blocking agents such as neuroleptics

Other commonly used drugs include metoclopromide and chlorpromazine

Other drugs:
Tetrabenazine
Calcium channel blockers (flunnarizine, cinnarizine)
Amiodarone
Lithium
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