Parkinson's Flashcards
what are the pathological changes seen with Parkinson’s?
degeneration of dopamine neurones within the substantia nigra
accumulation of Lewy bodies (initially substantia nigra then widespread)
is Parkinson’s symmetrical or asymmetrical?
asymmetrical onset - initially affected side will always be worse
red flag -> absence of asymmetry
what are the main motor symptoms in Parkinson’s?
tremor
rigidity
bradykinesia
what are the main non motor symptoms in Parkinson’s?
REM sleep disorders
autonomic - constipation, urinary urgency, frequency
depression, dementia, personality changes
how is Parkinson’s diagnosed?
clinically
if there is any uncertainty SPECT scan can be done
what is the gold standard treatment for Parkinson’s?
levodopa and carbidopa
(dopamine precursor and peripheral antagonist to prevent breakdown)
- taken same time everyday
what are the side effects of levodopa?
nausea and vomiting
dyskinesia/dystonia (involuntary writhing movements)
‘off states’
psychosis, hallucinations, reduced impulse control
what are the names of some dopamine agonists?
roprinirole
pramipexole
apomorphine
what is the name of a COMT inhibitors?
entacapone
what are the names of some MOAB inhibitors?
selegeline
rasagiline
what is apomorphine used for in Parkinson’s?
rescue for sudden off states
what is one of the most common side effects of the medication for Parkinson’s? what is used to treat it?
nausea
-> domperidone
selective to peripheral dopamine so won’t affect activity of levodopa in brain
what is Parkinsonism? how is it different to PD?
associated symptoms but defined underlying cause
absence of asymmetry, fast progression, sensory disturbance and pyramidal signs
what is progressive supranuclear palsy?
vertical gaze palsy
lack of tremor
early insatiability and falls
speech and swallowing problems
what is seen on MRI in progressive supranuclear palsy?
Mickey Mouse sign
what is multi-system atrophy?
pyramidal signs
jerky, postural tremor
ataxia and cerebellar signs
early autonomic disturbance - postural hypotension, bladder dysfunction
what is seen on MRI of multi-system atrophy?
hot cross bun sign
cerebellar and pontine atrophy
how is vascular Parkinson’s differentiated from PD?
caused by multiple small infarcts
mainly gain disturbance
poor levodopa response
how is dementia with lewy bodies differentiated from PD?
cognitive decline with visual hallucinations
- cognitive decline before Parkinson symptoms
what drugs can cause drug induced Parkinson’s?
anti-psychotics
amiodarone
metaclopramide
what is Wilson’s disease?
hepatic and renal failure
behavioural changes and cognitive decline
- keyser fisher rings in the eyes
what is a resting tremor?
a tremor that occurs when muscles are relaxed
what is a postural tremor?
tremor that is absent at rest and worse when maintaining a posture
doesn’t get worse with movement
what can cause a postural tremor?
anxiety
alcohol withdrawal
benign essentail tremor
what is the genetic aspect of a benign essential tremor?
autosomal dominant condition
what are the features of a benign essential tremor?
worse if arms outstretched
bilateral, fast, low amplitude tremor
symptoms improve with alcohol and rest
what is the treatment for a benign essential tremor?
propanolol
what is an intention tremor?
task orientated and made worse throughout the range of movement
what can cause an intention tremor?
cerebellar disease (MS, stroke, haemorrhage)
what is dystonia?
involuntary, sustained muscle spasms that result in abnormal posturing and repetitive movements in the context of an associated tremor
what can cause drug induced dystonia?
levodopa
anti-psychotics
metoclopramide
how does acute dystonia present?
torticollis (cervical neck)
trismus (jaw clenching)
oculogyric crisis (eyes drawn up)
how do you treat dystonia?
anti-spasmodics -> baclofen
botox (focal dystonia)
anti-cholinergic -> procyclidine (acute dystonia)
what is chorea?
non-rhythmic irregular purposeless movements that move from one body part to another
what genetic condition is chorea seen in?
Huntington’s disease
what is the genetic mutation seen in Huntington’s disease?
autosomal dominant
CAG expansion on chromosome 4
what does it mean if Huntington’s shows acceleration?
gets worse as it is passed down through the generations
what are the early symptoms seen in huntington’s disease?
clumsiness, chorea
irritability, agitation, depression
what are the advanced symptoms seen in hungtington’s disease?
chorea, myoclonus, rigidity, fits
cognitive decline and dementia
loss of ability to speak of swallow
saccadic eye movements
what is the management for Huntington’s disease?
supportive treatment
15 year life span after diagnosis
what is syndemans chorea?
self-limiting chorea usually seen in children
develops after strep throat
what is myoclonus?
sudden, involuntary focal or generalised muscle jerks
what condition is myoclonus seen in? what is the triad of symptoms it presents as?
Creutzfeldt–Jakob disease
dementia, ataxia, myoclonus
