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Neurology SB > Parkinson's Disease and Parkinsonism > Flashcards

Parkinson's Disease and Parkinsonism Flashcards

1
Q

what are features suggestive of a pyramidal/UMN lesion

A

muscle rigidity/increased tone
spasticity
hyperreflexia

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2
Q

what are features suggestive of a hyperkinetic (too much) extrapyramidal lesion

A 
Dystonia,
Tics,
Myoclonus
Chorea
(Tremor)
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3
Q

what are features suggestive of a hypokinetic (too little) extrapyramidal lesion

A

Parkinsonism

Parkinson’s disease

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4
Q

what are features of a problem in the cerebellum

A

ataxia

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5
Q

what is the features of the Parkinsonian syndrome

A

rigidity
akinesia / bradykinesia
resting tremor

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6
Q

what is dystonia

A

prolonged muscle spasms and abnormal postures

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7
Q

what is chorea

A

Fragments of movements flow irregularly from one body segment to another causing a dance-­‐like appearance.

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8
Q

what is chorea-ballismus

A

if amplitude of these irregular movements is large

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9
Q

what does PD present with

A 
tremor
muscle rigidity
akinesia = inability to produce movement
rest tremor
gait
postural impairment
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10
Q

what are the subtypes of PD

A

tremor dominant

non-tremor dominant

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11
Q

which type is associated with a slower rate of progression and less functional disability

A

tremor dominant

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12
Q

what are non motor features of PD

A
  • olfactory dysfunction
  • cognitive impairment e.g. dementia
  • psychiatric symptoms e.g. visual hallucinations, depression
  • sleep disorders e.g. REM sleep behaviour disorder
  • pain/aching limbs
  • fatigue
  • micrographia
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13
Q

why are non motor features important to recognise

A

often present before onset of classical motor features

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14
Q

what is the ‘honeymoon phase’ in PD

A

motor features of PD initially respond well to symptomatic therapies before deteriorating

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15
Q

what is rapid eye movement sleep behaviour disorder

A

abnormal or disruptive behaviours which occur during rapid eye movement sleep, often related to dream enactment

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16
Q

Ix for rapid eye movement sleep behaviour disorder

A

over night polysomnography

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17
Q

Tx of rapid eye movement sleep behaviour disorder

A

clonazepam or melatonin at bedtime

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18
Q

how is a diagnosis of PD made

A

Clinically

there is no diagnostic test

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19
Q

what are the 3 steps needed for a diagnosis of PD

A

1 - diagnosis of parkinsonian syndrome
2 - exclusion criteria for PD
3 - supportive prospective positive criteria for PD

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20
Q

what are the pathological features of PD

A

degeneration of dopaminergic neurones in the substantia nigra in the basal ganglia

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21
Q

what is a neurohistological hallmark of PD

A

lewy bodies

22
Q

mutations in what genes are associated with PD

A

SNCA
LRRK2
Parkin
GBA

23
Q

what does SNCA do

A

encode the protein alpha-synuclein

24
Q

what are mutations in LRRK2 and parkin most commonly responsible for

A

LRRK2 - dominant PD

Parkin - recessive PD

25
Q

what mutation carrier the greatest genetic risk factor for PD

A

GBA

26
Q

when should treatment be started in PD

A

when symptoms cause disability or discomfort

aiming to improve QOL and function

27
Q

what are SE of dopamine agonists

A 
nausea
daytime somnolence
oedema
pathological gambling
hypersexuality
binge eating
compulsive spending 
hallucinations 
drug induced psychosis
28
Q

what are SE of levodopa

A

nausea
daytime somnolence
oedema

long term use can cause motor complications

  • dyskinesia
  • motor fluctuations
29
Q

in who should dopamine agonists be avoided in

A

Hx of addiction
OCD
Cognitive impairment

30
Q

what drugs can be added to reduce dopamine fluctuations

A
  • dopamine agonists
  • MAOB inhibitor
  • COMT inhibitor
31
Q

how is psychosis in PD managed

A

clozapine
or
quetiapine

32
Q

what is the major SE of clozapine

A

agranulocytosis

33
Q

what Tx is used for psychosis in PD in patients with pre-existing dementia

A

Cholinesterase inhibitors e.g. rivastigmine

34
Q

what is bradykinesia

A

slowness of movement with progressive loss of amplitude or speed during attempted rapid alternating movements of body segments

35
Q

how can bradykinesia be assessed

A

asking the patient to perform repetitive movements as quickly and widely as possibly (opening and closing the hand, foot tapping)

asking them to stand up

36
Q

what is hypomimia, hypophonia and micrographia

A

hypomimia - decreased facial expression and eye blinking

hypophonia - soft speech

micrographia - progressively smaller handwriting

37
Q

what is a resting tremor

A

Rhythmic involuntary movement [of affected body part] at rest that vanishes with active movement

38
Q

what is the phenomenon ‘reemerging tremor’

A

tremor reappears after few seconds when arms held outstretched

39
Q

what is the most distinguishing resting tremor

A

“pill-rolling”

40
Q

what odd places can a tremor also affect

A

lower limbs
jaw
tongue

41
Q

what is rigidity

A

increased muscle tone felt during examination by passive movements

resistance is felt throughout full range of movement

no increase with higher mobilising speed

42
Q

what is a positive Froment’s manoeuvre

A

rigidity increases in examined body segment by voluntary movement of other body parts

43
Q

what are features of the Parkinsonian gait

A
  • slow, short, shuffling steps
  • decreased arm swing
  • slow turning with multiple small steps
  • freezing
  • festination
44
Q

what is meant by ‘a positive levodopa’ challenge

A

when the patient was given Levodopa their symptoms got better = likely PD

45
Q

what is vascular parkinsonism

A

Parkinsonism affects predominantly lower limbs

46
Q

what are features of vascular parkinsonism

A 
rest tremor is uncommon
spasticity
hemiparesis
pseudobulbar palsy
poor levodopa response
47
Q

what is a common cause of degenerative parkinsonsims

A

multi system atrophy

48
Q

what are Sx of multi system atrophy

A
  • dysautonomia
  • cerebellar features
  • parkisonism
  • jerky postural tremor
  • generalised hyperreflexia
  • extensor plantar response
49
Q

what is seen on MRI in multi system atrophy

A

cerebellar and pontine atrophy

- “hot cross bun” sign

50
Q

what is Fragile X-­‐tremor ataxia syndrome (FXTAS)

A

Late-­‐onset (>50 years) neurodegenerative disorder with an abnormal number of CGG repeats in the FMR1 gene

51
Q

what is a reversible cause of dementia

A

Normal pressure Hydrocephalus

52
Q

what is the Sx of Normal pressure Hydrocephalus

A

triad of

  • dementia
  • urinary incontinence
  • gait abnormality

[DUG]

Neurology SB (23 decks)

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