Parkinson's disease diagnosis Flashcards
What test should be considered when a diagnosis of parkinson’s disease is in doubt?
A levodopa or apomorphine challenge should be considered when dx is in doubt. All other tests (olfaction, repeat MRI, PET, automatic testing) are not based on sufficient evidence to be clinically useful
What classic sign is suggestive of PSP?
“While not always the earliest finding, the diagnosis of progressive supranuclear palsy is confirmed by the
appearance of vertical gaze paresis.”
What classic features are suggestive of CBD?
Cortical-basal ganglionic degeneration can have a similar presentation as idiopathic Parkinson disease in addition to cortical features including hand apraxia and cortical sensory loss.
Patients tend to not respond to levodopa
MRI, in some patients, demonstrates marked cortical asymmetry. Pathology demonstrates neuronal loss and classic ballooned neurons.”
What classic features are suggestive of MSA?
The diagnosis of probable multiple system atrophy can be made in a patient with parkinsonism, symptoms of autonomic failure (typically beginning with bladder and erectile dysfunction, with prominent orthostasis on examination) and no response to levodopa.
Writer’s cramp: what is it?
Writer’s cramp, a form of focal dystonia, is an activity-specific movement disorder associated with discomfort and abnormal posturing without more generalized symptoms.
What is a dopamine transporter scan? Why is it useful?
The dopamine transporter scan utilizes a radiopharmaceutical agent paired with SPECT (single photon emission computed tomography) imaging to measure availability of striatal dopamine. It cannot distinguish among conditions that show depleted dopamine in the striatum but it should be normal in patients with essential tremor.
What are some premotor features of idiopathic parkinson’s disease?
Anosmia, REM sleep behavior disorder, constipation and depression are commonly described premotor features of idiopathic Parkinson disease and can predate the diagnosis by several years.
