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Neurology > Parkinson's disease and Parkinsonism > Flashcards

Parkinson's disease and Parkinsonism Flashcards

1
Q

The symptoms of dystonia, tick, myoclonus, chorea and tremor are due to a problem in what part of the motor system?

A

Basal ganglia

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2
Q

Spasticity is due to a problem in what part of the motor system?

A

Corticospinal tract

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3
Q

Ataxia is due to a problem is which part of the motor system?

A

Cerebellum

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4
Q

What are the three components of the parkinsonian syndrome?

A

Rigidity
Akinesia/Bradykinesis
Resting tremore

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5
Q

What is chorea?

A

Uncontrolled writhing movements, sometimes described as “dancing”

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6
Q

What is ballismus?

A

Large chorea movements

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7
Q

What two places do you get atrophy in parkinson’s disease?

A

Substantia nigra

Locus coeruleus

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8
Q

What does the locus coeruleus produce?

A

Noradrenaline

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9
Q

Where is the locus coeruleus?

A

A nucleus in the pons

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10
Q

What is the main neurohistological hallmark in parkinson’s disease?

A

Lewy bodies

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11
Q

What are the four motor symptoms of parkinson’s disease?

A

Bradykinesia
Resting tremor
Rigidity
Postural and gait impairment

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12
Q

What word describes decreased facial expression and eye blinking?

A

Hypomimia

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13
Q

What work describes a quiet voice?

A

Hypophonia

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14
Q

What word describes progressively smaller handwriting?

A

Micrographia

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15
Q

What clinical examinations would you perform to assess bradykinesia?

A

Askinf patients to perform repetitive movements as quickly and widely as possible eg;

  • Opening and closing the hand
  • Tapping the foot
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16
Q

What kind of tremor is seen in parkinson’s disease?

A

Resting tremor

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17
Q

When is it best to observe a tremor in parkinson’s disease?

A

When the patient is concentrating on a mental tae (eg counting backwards from 100)

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18
Q

Does a resting tremor get better or worse on movement?

A

Usually vanishes on active movement

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19
Q

What differentiates rigidity from spasticity?

A

Rigidity: Felt through full range of movememt “lead pipe”
Spasticity: Velocity dependant “clasp knife”

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20
Q

What is cog wheel rigidity?

A

Resting tremor + lead pipe rigidity. It is jerky rigidity most clearly felt at the wrist.

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21
Q

What is a parkinsonian gait?

A

Slow, narrow based with short shuffling steps. Also festination

22
Q

What is festination?

A

very fast succession of steps and difficulty stopping, often seen in parkinsons

23
Q

List the non motor symptoms of parkinson’s disease?

A 
Early:
Hyposmia,
REM,
constipation,
depression
Late:
Dementia
Hallucinations
24
Q

In someone with parkinson’s disease what happens when you give them a course of levodopa?

A

Rapid relief of symptoms (this isn’t permanent)

25
Q

Give two examples of dopamine functional imaging tests

A
  • PET scan with fluoro dopa

- Dopamine transporter imagine with single photon emission

26
Q

List some red flags of parkinsons disease?

A

– Symmetrical symptoms
– Severe axial or lower limb involvement*
– Frequent falls*
– Fast disease progression
– Eye movement
disorder
- Other movement disorders such as tics, myoclonus and chorea
- Pyramidal or cerebellar dysfunction
- Bulbar or pseudobulbar features
- Parietal associative sensory disturbances
- Apraxia
- Severe cognitive deterioration or psychosis
- Marked autonomic dysfunction
- Negative levodopa challenge

27
Q

A 77 year old man presents with lower body rigidity. He has no resting tremor and poor response to levodopa.

A

Vascular parkinsonism

28
Q

How would you confirm a diagnosis of vascular parkinsonism?

A

Structural brain imaging

29
Q

What class of drugs causes parkinsonian symptoms?

A

Any block that blocks the action of dopamine (especially neuroepileptic drugs)

30
Q

What kind of tremor is most common with drug induced parkinsonism?

A

Postural tremor

31
Q

Do the symptoms in drug induced parkinsonism tend to be symmetrical or asymmetrical?

A

Symmetrical

32
Q

A 75 year old women presents with her family as she keeps getting lost and running away. She has profound memory loss and also talks off hallucinations.

A

Dementia with lewy bodies

33
Q

What disease encompasses a triad of autonomic dysfunction, cerebellar features and parkinsonism?

A

Multi system atrophy

34
Q

A 72 year old lady presents with a constipation, jerky postural tremor and clumsiness. On examination she walks with a wide based gait and she has generalized hyperflexia and extensor plantar responses.

A

Multi system atrophy

35
Q

What will the MRI scan most likely show in multi - system atrophy?

A

Cerebellar and pontine atrophy
OR
Hyperintense rim surrounding the putamen in T2 weighted scan.

36
Q

A 69 year old women presents with falls, slurred speech and a stiff neck. On examination her neck is tilted backwards and her eyes appear to be staring. You do a levodopa challenge test and there is no response.

A

Progressive supranuclear palsy

37
Q

What is the genetic problem is fragile X ataxia syndrome?

A

Abnormal number of CGG repeats in the FMR1 gene

38
Q

A 67 year old female comes to your clinic. She has cerebellar gait ataxia, an intention tremor and complains of constipation. She has a disabled son.

A

Fragile X tremor ataxia syndrome

39
Q

What drug would you give to treat erectile dysfunction is patient with parkinsons disease?

A

Sidenfil

40
Q

What is the initial management for a patient newly diagnosed with parkinson’s disease?

A

50mg levodopa 3 x daily

41
Q

What are the main side effects of levodopa?

A

“Peak dose dyskenesias” = involuntary movemnts such as tics & corea
Wearing off
Sudden off states

42
Q

What drug should levodopa be combined with to increase its peripheral action?

A

Peripheral dopa decarboxylase inhibitor (Carbidopa)

43
Q

What other drugs (aside from levodopa) are used in the treatment of the motor symptoms of parkinson’s disease?

A
  • Dopamine agonists eg bromocriptine and peroglide
  • Catechol - 0 - methyltransferase inhibitors eg entacapone, tolcapone
  • Amantadine
44
Q

What non drug treatment is useful in selected cases of parkinson’s disease?

A

Deep brain stimulation

45
Q

Are the symptoms in parkinson’s disease usually symmetrical or asymmetrical?

A

Asymmetrical

46
Q

What are the four most important motor symptoms of parkinsons disease?

A

Resting tremor
Rigidity
Bradykinesia
Postural instability

47
Q

Name a drug that is contraindicated in parkinsons disease? Why?

A

Haloperidol. It blocks dopamine so will worsen the symptoms of parkinsons.

48
Q

What are the three cardinal symptoms of parkinsons disease?

A

Resting Tremor
Dysdiadokinesis
Rigidity

49
Q

What medicine is prescribes alongside L Dopa in parkinsons disease?

A

DOPA decarboxylase inhibitor (cabidopa)

This prevents the peripheral metabolism of L Dopa

50
Q

What is the locus correlus?

A

Nucleus in the pons involved with physiological responses to stress and panic.
Principal site for brain synthesis of noradrenaline.

Neurology (45 decks)

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