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Medicine Phase 2a Neuro > Parkinson’s disease > Flashcards

Parkinson’s disease Flashcards

1
Q

What is it?

A

Progressive disorder of central nervous system, which is due to dopamine depletion

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2
Q

Risk factors

A

Male gender
Genetic component
Environmental exposure to insecticides, pesticides and herbicides

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3
Q

Pathophysiology

A

Decrease in dopamine producing cells in pars compacta region of the substantia nigra
Dopamine produced is secreted to the Putamen and Caudate nucleus
Increase in lewy bodies in substantia nigra

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4
Q

Where is substantia nigra

A

Midbrain

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5
Q

Signs and symptoms

A 
Facial TRAPS
Face - expressionless
Tremor (Resting tremor)
Rigidity
Akinesia
Postural instability
Shuffling gait
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6
Q

Investigations

A

No specific test - clinical diagnosis:
CT scan and MRI scan may be arranged but these are usually normal
PET, SPECT and Ioflupane (DaTSCAN) may measure basal ganglia dopaminergic function

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7
Q

Conservative treatment

A

Patient education
Rehabilitation to improve gait and mobility
Regular assessment of activities of daily living

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8
Q

Medical treatment

A

Levodopa
Carbidopa
Selegiline
Amantadine

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9
Q

Surgical treatment

A

This option is unlikely, due to improvements in medical treatment

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10
Q

Complications

A

Dysphagia
Dementia
Increased risk of falls
Erectile dysfunction

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11
Q

Physiology of levodopa

A

Crosses the blood-brain barrier (BBB) where it is converted to dopamine

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12
Q

Physiology of carbidopa

A

Always given with levodopa
It is a dopa decarboxylase inhibitor
Prevents levodopa being metabolised to dopamine in other regions of the body
Thus acts to decrease peripheral side effects

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13
Q

Physiology of selegiline

A

inhibits monoamine oxidase B (MAO-B)

this enzyme breaks down dopamine

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14
Q

Physiology of amantadine

A

dopamine agonist

decreases symptoms of Parkinsons

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15
Q

What is it

A

Degenerative movement disorder caused by a REDUCTION IN DOPAMINE in the SUBSTANTIA NIGRA

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16
Q

*What structures make up the basal ganglia

A
  • Striatum (composed of the putamen & caudate nucleus)
  • Globus pallidus (external & internal)
  • Substantia nigra
  • Subthalamic nucleus
17
Q

Which structure in the basal ganglia produces dopamine

A

Substantia nigra

18
Q

Risk factors

A

Increasing age
Male
Family history
Being a non-smoker?

19
Q

What is result of low dopamine

A

Thalamus will be inhibited

Decrease in movement

20
Q

What are the names of neuronal inclusions in Parkinsons that gradually become more widespread

A

Lewy-bodies

21
Q

Clinical presentation - onset

A

Onset of symptoms is gradual and commonly presents with impaired dexterity or unilateral foot drop
Onset is ASYMMETRICAL - one side always worse than the other

22
Q

Describe the tremor in Parkinsons

A

Resting Tremor
Worse at rest and often ASYMMETRICAL
Pill-rolling of the thumb and fingers
Repetitive hand movements with worsening in rhythm the longer attempted

23
Q

Describe the rigidity in Parkinsons

A

Parkinsons is an Extrapyramidal lesion

  • Increased tone in the limbs and trunk
  • Limbs resists passive extension throughout movement (lead pipe rigidity or cogwheel when combined with tremor) - this is RIGIDITY
  • As opposed to the hypertonia of a UMN lesion, which is SPASTICITY where resistance falls away as the movement continues (clasp-knife)
  • Increased tone and thus rigidity over entire radius of joint movement
  • Can cause pain and problems with turning in bed
24
Q

State 2 main histopathological findings in the brain in this condition

A

Loss of dopaminergic neurones (in substantia nigra)

Lewy bodies

25
Q

What would you expect to see on a CT scan of this patients brain?

A

No pathology

26
Q

Patient with Parkinsons is treated with medication. State one class of drug used to provide symptomatic relief in Parkinson’s disease and give one named example of a drug from this class.

A 
Class - Dopamine agonists
Named example - Cabergoline
OR
Class - Monoamine oxidase B inhibitor
Named example - Selegiline
27
Q

State 4 clinical features the neurologist may expect to find on physical examination of Parkinsons patient

A

Resting tremor
Rigidity
Bradykinesia
‘Freezing’ when starting to walk/turn/cross threshold e.g. reduced arm swing

28
Q

Describe bradykinesia

A

Problems with daily activities e.g. doing up buttons, micrographia, expressionless face, dysdiadochokinesia

29
Q

Describe tremor in Parkinsons

A

Resting, commonly unilateral, Starts in the hands “pill rolling”

30
Q

Describe Rigidity in Parkinsons

A

Cogwheel like, stooped posture

31
Q

Describe gait in parkinsons

A

Shuffling, reduced arm swing, slow to start

32
Q

Describe postural instability in parkinsons

A

impaired balance, especially when trying to turn

Medicine Phase 2a Neuro (28 decks)

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