Parkinson's Flashcards
what is the pathophysiological cause of bradykinesia in Parkinson’s?
dopamine deficiency due to overstimulation of the internal globus palidus and sub thalamic nucleus (STN)
what is the pathophysiological cause of rigidity/hypertonia in Parkinson’s?
enhancement of the long latency stretch reflexes
what is the pathophysiological cause of postural instability in Parkinson’s?
loss and/or dysfunction of postural righting reflexes
what are the 4 Parkinson-like syndromes?
lewy body dementia
progressive supra nuclear palsy
multiple system atrophy
cortico-basal degeneration
what is the diagnostic criteria for Parkinson’s?
bradykinesia plus 2 or more…
- tremor (4-6 Hz resting)
- postural instability
- rigidity / hypertonia
exclude other causes of parkinsons
at least 3 supportive criteria
list features found on clinical examination in a patient with Parkinson’s.
Bradykinesia Rigidity / hypertonia Tremor Postural instability Shuffling gait Stooped posture Masked facies Hypokinetic dysarthria - Monopitch - Reduced vocal loudness - Abnormal fast rate of speech - Disruption of voice quality Micrographia Conjugate eye movement disorders (saccadic pursuit and hypometric saccades) Constipation Depression Dementia Fatigue
what is the first line investigation for suspected Parkinson’s?
dopaminergic agent trial
what imaging modality may be useful in the diagnosis of Parkinson’s?
dopamine transporter beta-CIT SPECT
what are differentials of Parkinson’s?
lewy body dementia multiple system atrophy drug-induced Parkinson's vascular parkinsons toxin exposure - MPTP, CO, manganese
what are the medical management options for Parkinson’s?
MAOB-inhibitor - selegiline Levodopa/carbadopa Dopaminergic agent i.e. Ropinirole Trihexyphenidyl Amantadine
what are the drug-related complications of Parkinson’s?
levodopa induced chorea / dyskinesia
impulse control disorder
psychosis
motor fluctuations
what are the non-drug related complications of Parkinson’s?
dementia
depression and anxiety
constipation
what is progressive supra nuclear palsy?
Parkinson syndrome
Presents like Parkinson’s but involves a vertical gaze palsy
what is multiple system atrophy?
Parkinson syndrome
presents like Parkinson’s but involves early autonomic dysfunction i.e. postural hypotension, impotence, urinary incontinence
what is cortico-basal degeneration?
Parkinson syndrome
Presents like Parkinson’s but involves spontaneous activity by an affected limb or akinetic rigidity of that limb
