Parkinsonism Flashcards
What are some environmental risk factors for Parkinson’s.
Prior head injury, pesticides, rural living, well drinking, B blockers,
What are some environmental factors that decrease your risk of Parkinson’s?
Tobacco smoking, Coffee, NSAIDs, Ca2+ blockers, Alcohol
What are some genetic risk factors for Parkinson’s.
+ve Family History
What genes are related to Parkinson’s?
LRRK2 - autosomal dominant
PARKIN - Autosomal recessive
What does management and treatment involve in Parkinson’s?
No curative treatment entirely symptomatic relief.
What is the main aim of symptomatic relief?
To increase intracerebral dopamine concentration or stimulate dopamine receptors
What are the mainstay drugs for symptomatic treatment of Parkinsons?
Levodopa
Dopamine Agonist
MAO B inhibitors
What is Levodopa?
A precursor to dopamine used to treat bradkinetic symptoms of parkinsonism.
List some common side effects of Levodopa/ Dopamine Agonists
Nausea
Oedema
Daytime sleepiness
When should dopamine agonists be avoided?
In cognitive impairment as increased risk of hallucination.
If someone with Parkinsonism presents with dementia like symptoms what is the treatment?
Acetylcholinesterase inhibitor
Give an example of an acetylcholinesterase inhibitor used in Parkinson’s.
Rivestigmine
If someone with Parkinson’s presents with depression what is the treatment?
SSRI
Citalopram
Setraline
If someone with parkisnons presents with psychosis what is the treatment?
Clozapine - Cognitive features
Quetiapine - Hallucination and Delusions only
If someone with parkinsons presents with sleep disorders what is the treatment ?
Melatonin
If someone with parkinsons presents with fatigue what is the treatment?
Methylphenidate
Modanfil
List some red flags in a patient with parkinsons.
Frequent falls Severe axial limb involvement Autonomic dysfunction Psychosis Dysfunction within Spinal columns i.e corticospinal
Where is predominantly affected in vascular parkinsons?
Lower limbs
Describe presentation of vascular Parkinsonism.
Rest tremor is uncommon
Sign of brain lesion I.e spasticity hemiparesis
Poor levodopa response
Lower limbs affected
How is vascular parkinsons diagnosed?
Structural brain imaging involved.
What is the key thing to note when a diagnosis of drug induced parkinsons is possible?
Onset after exposure to a new drug
Describe drug induced Parkinson’s.
Coarse symmetrical postural tremor
Improvement upon withdrawal of drug
What is a common cause of degenerative Parkinson’s?
Multi System Atrophy
When does multi system atrophy present?
60/70s
What are the main features of Multi system atrophy ?
Dysautonomia
Cerebellar features
Parkinsonism
Describe the presentation of multi system atrophy.
Hyperflexia - extensor plantar Pyrimidal signs Axial involvement Jerky postural tremor Severe dysarthria dysphonia
What is dysarthria?
Muscles required to speak are paralysed so unable to formulate words properly.
What is dysphonia?
Abnormal voice often hoarse
How does Multi system atrophy respond to levodopa?
Short lived
What might appear on the MRI of someone with Multi System Atrophy?
Hot Cross bun sign
Cerebellar and pontine atrophy
How does progressive supranuclear palsy present?
Symmetrical akinetic rigid syndrome
Early falls due to gait and imbalance
No tremor
Pseudobulbar symptoms
What is akinetic rigid syndrome?
Slowness in initiating movement and rigidity thought range of movement.
What pseudo bulbar symptoms are present in Supranuclear palsy?
Retrocollic - Neck bent backwards
Eyes wide open
What is the levodopa response in Progressive Supranuclear Palsy?
0
Someone with Fragile X associated tremor/ataxia syndrome presents how?
Cerebellar gait Ataxia Postural/Intention tremor Peripheral neuropathy Cognitive decline
Who is at risk of fragile X associated tremor/ ataxia syndrome?
Carries of the fragile X syndrome gene.
Presents in 70s
What imaging is used in fragile X associated tremor/ ataxia syndrome and what would you expect to see?
MRI T2
Hyperintensities in middle cerebellar peduncles
