Parkinson Dz and Dopamine Disorders Flashcards
What are some of the hallmark S/Sx of Parkinsonism?
TRAP-Parkinson's Tremor Rigidity Akinesia/Bradykinesia Postural Instability
You have a PT you suspect of Parkinsonism in your clinic; what should remain on your differential?
Parkinson's Dz Dementia w/ Lewy bodies Multiple system atrophy Depression Progressive supranuclear palsy Corticobasal degeneration Huntington Dz Idiopathic and Familial Basal Ganglia Calcification
During a neuro exam of your 75 y/o PT you note a downward gaze dysfunction (slow in nature) and backward twitching (retrocollis); what condition might you suspect?
Progressive Supranuclear Palsy
Isolated tremors of the chin or lips are most likely a manifestation of what disease?
Essential tremor
What is the clinical picture for Vascular Parkinsonism? What differentiates it from Parkinson Dz?
Risk factor –> Cerebrovascular Dz
NO REST TREMOR
Gait ataxia and postural instability
Unresponsive to Levodopa Tx
PT presents with urinary incontinence, gait instability, and cognitive impairment. You order a CT/MRI and
Normal Pressure Hydrocephalus
CT/MRI
CSF-Tap/Shunt
What is Huntington’s Disease caused by?
What are the presenting S/Sx?
Trinucleotide repeat on chromosome 4
Rigid hypokinetic movement
Sleep-related burning sensations and paresthesias are experienced by a PT. It only improves with movement and is exacerbated at night. What would you Rx this PT?
RLS (Willis-Ekbom)
DOPAMINE AGONIST (i.e. Pramipexole, Ropinirole)
Alpha-2-delta calcium channel ligand (Gabapentin)
Benzos (Clonazepam) not good, b/c just sedating them through their S/Sx
Opioids
Iron Supplementation
What criteria should you use to distinguish Parkinsonian Syndromes from PD?
Lack of tremor Early dysautonomia Symmetry at onset Rapid progression (Stage 3 in 3yrs) Poor response to levodopa Falls at presentation/early Dz
What is the most common neurodegenerative movement disorder?
Parkinson’s Disease
What is happening in Parkinson’s Disease?
Degeneration of dopamine neurons of the substantia nigra leads to unchecked excitatory CNS neurotransmitter (acetylcholine) activity at the level of the basal ganglia
What are the common S/Sx of Parkinson Dz patients?
Resting tremor (3-7 Hz)
Bradykinesia to get moving, but then cant stop
Rigidity (cogwheel, jerking movement)
Fixed facial expressions (Myerson’s sign (tapping bridge of nose to elicit blink))
Postural instability
How would you clinically manage with Parkinson’s Dz?
Levodopa/Carbidopa (Sinemet) –> Most effective
Dopamine Agonists: (Bromocriptine, Pramipexole, Ropinirole)
Anticholinergics:
Antiglutaminergic agents
COMT- Inhibitors
Co-Enzyme Q10
MAO-B Inhibitors:
What imaging studies could you order for a PT to diagnose a suspected PD PT?
MRI
FDG
PET
DaT scan (dopamine tagged scan)
