Parkinson's disease and Parkinsonism Flashcards
The symptoms of dystonia, tick, myoclonus, chorea and tremor are due to a problem in what part of the motor system?
Basal ganglia
Spasticity is due to a problem in what part of the motor system?
Corticospinal tract
Ataxia is due to a problem is which part of the motor system?
Cerebellum
What are the three components of the parkinsonian syndrome?
Rigidity
Akinesia/Bradykinesis
Resting tremore
What is chorea?
Uncontrolled writhing movements, sometimes described as “dancing”
What is ballismus?
Large chorea movements
What two places do you get atrophy in parkinson’s disease?
Substantia nigra
Locus coeruleus
What does the locus coeruleus produce?
Noradrenaline
Where is the locus coeruleus?
A nucleus in the pons
What is the main neurohistological hallmark in parkinson’s disease?
Lewy bodies
What are the four motor symptoms of parkinson’s disease?
Bradykinesia
Resting tremor
Rigidity
Postural and gait impairment
What word describes decreased facial expression and eye blinking?
Hypomimia
What work describes a quiet voice?
Hypophonia
What word describes progressively smaller handwriting?
Micrographia
What clinical examinations would you perform to assess bradykinesia?
Askinf patients to perform repetitive movements as quickly and widely as possible eg;
- Opening and closing the hand
- Tapping the foot
What kind of tremor is seen in parkinson’s disease?
Resting tremor
When is it best to observe a tremor in parkinson’s disease?
When the patient is concentrating on a mental tae (eg counting backwards from 100)
Does a resting tremor get better or worse on movement?
Usually vanishes on active movement
What differentiates rigidity from spasticity?
Rigidity: Felt through full range of movememt “lead pipe”
Spasticity: Velocity dependant “clasp knife”
What is cog wheel rigidity?
Resting tremor + lead pipe rigidity. It is jerky rigidity most clearly felt at the wrist.
What is a parkinsonian gait?
Slow, narrow based with short shuffling steps. Also festination
What is festination?
very fast succession of steps and difficulty stopping, often seen in parkinsons
List the non motor symptoms of parkinson’s disease?
Early: Hyposmia, REM, constipation, depression Late: Dementia Hallucinations
In someone with parkinson’s disease what happens when you give them a course of levodopa?
Rapid relief of symptoms (this isn’t permanent)
Give two examples of dopamine functional imaging tests
- PET scan with fluoro dopa
- Dopamine transporter imagine with single photon emission
List some red flags of parkinsons disease?
– 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
A 77 year old man presents with lower body rigidity. He has no resting tremor and poor response to levodopa.
Vascular parkinsonism
How would you confirm a diagnosis of vascular parkinsonism?
Structural brain imaging
What class of drugs causes parkinsonian symptoms?
Any block that blocks the action of dopamine (especially neuroepileptic drugs)
What kind of tremor is most common with drug induced parkinsonism?
Postural tremor
Do the symptoms in drug induced parkinsonism tend to be symmetrical or asymmetrical?
Symmetrical
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.
Dementia with lewy bodies
What disease encompasses a triad of autonomic dysfunction, cerebellar features and parkinsonism?
Multi system atrophy
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.
Multi system atrophy
What will the MRI scan most likely show in multi - system atrophy?
Cerebellar and pontine atrophy
OR
Hyperintense rim surrounding the putamen in T2 weighted scan.
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.
Progressive supranuclear palsy
What is the genetic problem is fragile X ataxia syndrome?
Abnormal number of CGG repeats in the FMR1 gene
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.
Fragile X tremor ataxia syndrome
What drug would you give to treat erectile dysfunction is patient with parkinsons disease?
Sidenfil
What is the initial management for a patient newly diagnosed with parkinson’s disease?
50mg levodopa 3 x daily
What are the main side effects of levodopa?
“Peak dose dyskenesias” = involuntary movemnts such as tics & corea
Wearing off
Sudden off states
What drug should levodopa be combined with to increase its peripheral action?
Peripheral dopa decarboxylase inhibitor (Carbidopa)
What other drugs (aside from levodopa) are used in the treatment of the motor symptoms of parkinson’s disease?
- Dopamine agonists eg bromocriptine and peroglide
- Catechol - 0 - methyltransferase inhibitors eg entacapone, tolcapone
- Amantadine
What non drug treatment is useful in selected cases of parkinson’s disease?
Deep brain stimulation
Are the symptoms in parkinson’s disease usually symmetrical or asymmetrical?
Asymmetrical
What are the four most important motor symptoms of parkinsons disease?
Resting tremor
Rigidity
Bradykinesia
Postural instability
Name a drug that is contraindicated in parkinsons disease? Why?
Haloperidol. It blocks dopamine so will worsen the symptoms of parkinsons.
What are the three cardinal symptoms of parkinsons disease?
Resting Tremor
Dysdiadokinesis
Rigidity
What medicine is prescribes alongside L Dopa in parkinsons disease?
DOPA decarboxylase inhibitor (cabidopa)
This prevents the peripheral metabolism of L Dopa
What is the locus correlus?
Nucleus in the pons involved with physiological responses to stress and panic.
Principal site for brain synthesis of noradrenaline.
