Parkinsonism

Question 1

What are some environmental risk factors for Parkinson’s.

Answer 1

Prior head injury, pesticides, rural living, well drinking, B blockers,

Question 2

What are some environmental factors that decrease your risk of Parkinson’s?

Answer 2

Tobacco smoking, Coffee, NSAIDs, Ca2+ blockers, Alcohol

Question 3

What are some genetic risk factors for Parkinson’s.

Answer 3

+ve Family History

Question 4

What genes are related to Parkinson’s?

Answer 4

LRRK2 - autosomal dominant

PARKIN - Autosomal recessive

Question 5

What does management and treatment involve in Parkinson’s?

Answer 5

No curative treatment entirely symptomatic relief.

Question 6

What is the main aim of symptomatic relief?

Answer 6

To increase intracerebral dopamine concentration or stimulate dopamine receptors

Question 7

What are the mainstay drugs for symptomatic treatment of Parkinsons?

Answer 7

Levodopa
Dopamine Agonist
MAO B inhibitors

Question 8

What is Levodopa?

Answer 8

A precursor to dopamine used to treat bradkinetic symptoms of parkinsonism.

Question 9

List some common side effects of Levodopa/ Dopamine Agonists

Answer 9

Nausea
Oedema
Daytime sleepiness

Question 10

When should dopamine agonists be avoided?

Answer 10

In cognitive impairment as increased risk of hallucination.

Question 11

If someone with Parkinsonism presents with dementia like symptoms what is the treatment?

Answer 11

Acetylcholinesterase inhibitor

Question 12

Give an example of an acetylcholinesterase inhibitor used in Parkinson’s.

Answer 12

Rivestigmine

Question 13

If someone with Parkinson’s presents with depression what is the treatment?

Answer 13

SSRI
Citalopram
Setraline

Question 14

If someone with parkisnons presents with psychosis what is the treatment?

Answer 14

Clozapine - Cognitive features

Quetiapine - Hallucination and Delusions only

Question 15

If someone with parkinsons presents with sleep disorders what is the treatment ?

Answer 15

Melatonin

Question 16

If someone with parkinsons presents with fatigue what is the treatment?

Answer 16

Methylphenidate

Modanfil

Question 17

List some red flags in a patient with parkinsons.

Answer 17

Frequent falls
Severe axial limb involvement
Autonomic dysfunction
Psychosis
Dysfunction within Spinal columns i.e corticospinal

Question 18

Where is predominantly affected in vascular parkinsons?

Answer 18

Lower limbs

Question 19

Describe presentation of vascular Parkinsonism.

Answer 19

Rest tremor is uncommon
Sign of brain lesion I.e spasticity hemiparesis
Poor levodopa response
Lower limbs affected

Question 20

How is vascular parkinsons diagnosed?

Answer 20

Structural brain imaging involved.

Question 21

What is the key thing to note when a diagnosis of drug induced parkinsons is possible?

Answer 21

Onset after exposure to a new drug

Question 22

Describe drug induced Parkinson’s.

Answer 22

Coarse symmetrical postural tremor

Improvement upon withdrawal of drug

Question 23

What is a common cause of degenerative Parkinson’s?

Answer 23

Multi System Atrophy

Question 24

When does multi system atrophy present?

Answer 24

60/70s

Question 25

What are the main features of Multi system atrophy ?

Answer 25

Dysautonomia Cerebellar features Parkinsonism

Question 26

Describe the presentation of multi system atrophy.

Answer 26

``` Hyperflexia - extensor plantar Pyrimidal signs Axial involvement Jerky postural tremor Severe dysarthria dysphonia ```

Question 27

What is dysarthria?

Answer 27

Muscles required to speak are paralysed so unable to formulate words properly.

Question 28

What is dysphonia?

Answer 28

Abnormal voice often hoarse

Question 29

How does Multi system atrophy respond to levodopa?

Answer 29

Short lived

Question 30

What might appear on the MRI of someone with Multi System Atrophy?

Answer 30

Hot Cross bun sign | Cerebellar and pontine atrophy

Question 31

How does progressive supranuclear palsy present?

Answer 31

Symmetrical akinetic rigid syndrome Early falls due to gait and imbalance No tremor Pseudobulbar symptoms

Question 32

What is akinetic rigid syndrome?

Answer 32

Slowness in initiating movement and rigidity thought range of movement.

Question 33

What pseudo bulbar symptoms are present in Supranuclear palsy?

Answer 33

Retrocollic - Neck bent backwards | Eyes wide open

Question 34

What is the levodopa response in Progressive Supranuclear Palsy?

Answer 34

0

Question 35

Someone with Fragile X associated tremor/ataxia syndrome presents how?

Answer 35

``` Cerebellar gait Ataxia Postural/Intention tremor Peripheral neuropathy Cognitive decline ```

Question 36

Who is at risk of fragile X associated tremor/ ataxia syndrome?

Answer 36

Carries of the fragile X syndrome gene. | Presents in 70s

Question 37

What imaging is used in fragile X associated tremor/ ataxia syndrome and what would you expect to see?

Answer 37

MRI T2 | Hyperintensities in middle cerebellar peduncles