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Neurology Year 3 > Parkinsonism > Flashcards

Parkinsonism Flashcards

1
Q

What are some environmental risk factors for Parkinson’s.

A

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

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2
Q

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

A

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

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3
Q

What are some genetic risk factors for Parkinson’s.

A

+ve Family History

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4
Q

What genes are related to Parkinson’s?

A

LRRK2 - autosomal dominant

PARKIN - Autosomal recessive

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5
Q

What does management and treatment involve in Parkinson’s?

A

No curative treatment entirely symptomatic relief.

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6
Q

What is the main aim of symptomatic relief?

A

To increase intracerebral dopamine concentration or stimulate dopamine receptors

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7
Q

What are the mainstay drugs for symptomatic treatment of Parkinsons?

A

Levodopa
Dopamine Agonist
MAO B inhibitors

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8
Q

What is Levodopa?

A

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

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9
Q

List some common side effects of Levodopa/ Dopamine Agonists

A

Nausea
Oedema
Daytime sleepiness

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10
Q

When should dopamine agonists be avoided?

A

In cognitive impairment as increased risk of hallucination.

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11
Q

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

A

Acetylcholinesterase inhibitor

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12
Q

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

A

Rivestigmine

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13
Q

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

A

SSRI
Citalopram
Setraline

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14
Q

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

A

Clozapine - Cognitive features

Quetiapine - Hallucination and Delusions only

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15
Q

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

A

Melatonin

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16
Q

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

A

Methylphenidate

Modanfil

17
Q

List some red flags in a patient with parkinsons.

A 
Frequent falls
Severe axial limb involvement
Autonomic dysfunction
Psychosis
Dysfunction within Spinal columns i.e corticospinal
18
Q

Where is predominantly affected in vascular parkinsons?

A

Lower limbs

19
Q

Describe presentation of vascular Parkinsonism.

A

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

20
Q

How is vascular parkinsons diagnosed?

A

Structural brain imaging involved.

21
Q

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

A

Onset after exposure to a new drug

22
Q

Describe drug induced Parkinson’s.

A

Coarse symmetrical postural tremor

Improvement upon withdrawal of drug

23
Q

What is a common cause of degenerative Parkinson’s?

A

Multi System Atrophy

24
Q

When does multi system atrophy present?

A

60/70s

25
Q

What are the main features of Multi system atrophy ?

A

Dysautonomia
Cerebellar features
Parkinsonism

26
Q

Describe the presentation of multi system atrophy.

A 
Hyperflexia - extensor plantar
Pyrimidal signs
Axial involvement 
Jerky postural tremor
Severe dysarthria dysphonia
27
Q

What is dysarthria?

A

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

28
Q

What is dysphonia?

A

Abnormal voice often hoarse

29
Q

How does Multi system atrophy respond to levodopa?

A

Short lived

30
Q

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

A

Hot Cross bun sign

Cerebellar and pontine atrophy

31
Q

How does progressive supranuclear palsy present?

A

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

32
Q

What is akinetic rigid syndrome?

A

Slowness in initiating movement and rigidity thought range of movement.

33
Q

What pseudo bulbar symptoms are present in Supranuclear palsy?

A

Retrocollic - Neck bent backwards

Eyes wide open

34
Q

What is the levodopa response in Progressive Supranuclear Palsy?

A

0

35
Q

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

A 
Cerebellar gait
Ataxia
Postural/Intention tremor
Peripheral neuropathy
Cognitive decline
36
Q

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

A

Carries of the fragile X syndrome gene.

Presents in 70s

37
Q

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

A

MRI T2

Hyperintensities in middle cerebellar peduncles

Neurology Year 3 (29 decks)

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