Parkinson's Flashcards
pathophysiology of parkinsons
degeneration of dopaminergic neurones in substantia nigra (of basal ganglia)
quadridad of parkinsons + key feature
rigidity
tremor
bradykinesia
postural instability - falls
unilateral onset
3 aspects of rigidity in parkinsons
leadpipe
cogwheel
festinating (shuffling) gait
aspects of tremor in parkinsons
pill rolling
unilateral
resting
fine tremor
PURF
4 aspects of bradykinesia in parkinsons
expressionless face
slow monotonous speech
micrographia
gait - slow, shuffling, flexed trunk
differentials for parkinsons
drug-induced lewy body dementia MSA + PSP corticobulbar degeneration normal pressure hydrocephalus
multisystem atrophy
cerebellar signs
prominent early autonomic problems - bowel, bladder, hypotension
symmetrical
PSP
swallowing problems (pronounced)
axial rigidity
vertical gaze palsy (lose elevation + depression of eyes)
early falls
SAVE
hummingbird sign on MRI
corticobulbar degeneration
apraxia aphasia alien limb cortical sensory deficit dementia
AAACD
parkinsons - investigations
clinical diagnosis
MRI - rule out rare causes of parkinsonism
1st line management of PD + indications
severe/elderly - levodopa + dopa decarboxylase inhibitor (co-beneldopa)
moderate - dopamine agonist (ropinirole, pramipexole)
mild - monoamine-oxidase-B-inhibitor (rasagaline, selegiline)
dopamine agonists SEs
sleep attacks
confusion + hallucinations
impulse control disorders
levodopa SEs
N+V
postural hypotension
over time - dyskinesias + on/off phenomena
management of PD - add-ons to levodopa
monoamine oxidase B inhibitors (rasagiline)
COMT inhibitor (entacapone) - prevent end of dose deterioration of co-carelsopa (prolong effects of levodopa)
amantadine - reduces dyskinesia
non-drug management of PD
physio, OT, SALT
supervised exercise
home modifications
manage dementia, depression, sleep
6 non-motor symptoms of PD
dementia + depression
sleep - lashing + shouting
hypersalivation + swallowing problems
constipation + bladder
3 features - differentiating parkinsons from other diseases
no weakness
unilateral
resting tremor
causes of tremor
vascular salbuatmol (fine, bilateral) parkinsonism essential cerebellar thyrotoxicosis
V-SPECT
normal pressure hydrocephalus triad? what is absent in NPH?
dementia
gait disturbance
urinary incontinence
no tremor or rigidity
drug-induced parkinsons - which drugs? key feature?
antipsychotics + metoclopramide
symmetrical rigidity
lewy body dementia
hallucinations
essential tremor
worse on movement - action tremor
familial
in jaw + legs
coarse tremor
DANISH
D - dysdidadokinesia (can’t quickly flip hand) + dysmetria (past pointing)
A - ataxia (incoordination of muscles; unsteady on feet towards side of lesion, rebounding arm if pushed)
N - nystagmus + blurred vision
I - intention tremor
S - slurred speech
H - hypotonia (weakness on side of lesion)
may have UMN signs
thyroid tremor
fine bilateral tremor
goitre
eye signs
tachycardia
