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Neurology > Parkinsonism and Parkinson's Disease > Flashcards

Parkinsonism and Parkinson's Disease Flashcards

1
Q

Where are the three main origins of movement disorders?

A

Corticospinal ie pyramidal
Basal Ganglia ie extrapyramidal
Cerebellum

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2
Q

What kind of symptoms occur in a corticospinal tract lesion

A

Weakness

Spasticity

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3
Q

What kind of symptoms occur in a basal ganglia lession

A

Hyperkinetic e.g. dystonia, tics, myoclonus, chorea

Hypokinetic e.g Parkinson’s

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4
Q

What symptoms occur due to cerebellar lesions

A 
DANISH
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech -dysarthria
Hypotonia
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5
Q

What is dystonia

A

prolonged muscle spasms and abnormal postures

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6
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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7
Q

what is ballismus

A

high amplitude choreo form movements

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8
Q

What is the parkinsonian syndrome

A

rigidity
akinesia/bradykinesia
resting tremor

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9
Q

What is Parkinson’s disease?

A

Tremor, rigidity, akinesia, impairement of locomotion and posture +non motor symptoms
Eventual dementia

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10
Q

What is the neurohistological hallmark of Parkinson’s disease

A

Lewy bodies

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11
Q

Which area of the basal ganglia is affect in parkinson’s

A

Loss of dopaminergic cells in substancia nigra

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12
Q

What are the strongest risk factors for parkinson’s

A 
old age
family history - in about 15 percent of cases of parkinsons there is a positive family history
pesticide exposure (possibly)
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13
Q

What may be protective of parkinsons

A

smoking
NSAIDs
high uric acid levels

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14
Q

What are the motor symptoms of Parkinson;s

A

bradykinesia
rest tremor
rigidity
postural and gait impairement

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15
Q

What is bradykinesia

A

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

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16
Q

what is hypomimia

A

decreased facial expression and eyeblinking

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17
Q

what is hypophonia

A

reduced voice volume

18
Q

what is micrographia

A

progressively smaller handwriting

19
Q

What are the characteristics of a resting tremor

A

Rhythmic oscillatory involuntary movement of affected body part at rest
vanishes with active movement
can ‘reemerge’ when hands held outstretched

20
Q

What kind of resting tremors are there

A

pill rolling
finger- flexion extension or abduction and adduction
tremor can effect lower limbs, jaw or tongue

21
Q

when is a resting tremor best seen

A

when patient is focused on a mental task such as counting back from 100

22
Q

What is rigidity

A

increased muscle tone felt on passive movement throughout the full range of movement
does not increase with higher speed of movement - as such distinguishing it from spasticity

23
Q

What is froment’s maneuver

A

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

24
Q

what kind of posture and gait occurs in parkinsonism

A

stooped posture- impaired postural reflexes
slow gait, narrow base, shuffling, decreased arm swing, slow turning with multiple steps
freezing
festination

25
Q

what is camptocormia

A

extreme anterior tuncal flexion

26
Q

Name some non motor features of parkinson’s

A

dementia, hallucinations, hyposmia, REM, constipation, depression

27
Q

What is myoclonus

A

a rapid involuntary twitching motion by a muscle group

28
Q

What is the disadvantage of dopamine functional imaging

A

unable to distinguish Parkinson’s from other causes of degenerative parkinsonism - however it will be normal in essential tremor, dystonic tremor, psychogenic parkinsonism

29
Q

What investigations can be done if parkinsons disease is suspected

A

Rule out other cause of asthenia - hypothyroid, anaemia
Structural brain imaging
PET with fluoro-dopa
Dopamine transporter (DAT) imaging with single photon emission CT
Positive levodopa challenge
genetic testing where appropriate

30
Q

What are the ‘red flag’ parkinsons presentations

A 
Absence of asymmetry of symptoms
severe axial or lower limb involvement
fast progression
frequent falls
eye movement disorder
Tics, myoclonus or chorea
Pyramidal or cerebella dysfunction
Bulbar/pseudobulbar features
Parietal associative sensory disturbances
apraxia
cognitive disfunction or psychosis
autonomic dysfunction
negative levodopa challenge
31
Q

what are the common causes of parkinsonism

A 
PD
drug induced
progressive supranuclear palsy
Lewy body dementia
Vascular parkinsonism
32
Q

what are the less common causes of parkinsonism

A 
infectious and post infectious
toxins eg heroine, manganism
metabolic/endocrine eg carbon monoxide
head trauma
Hallervorden Spatz syndrome
33
Q

what drugs can cause parkinsonism

A 
prochlorperaziine
metoclopramide
antipsychotics
calcium channel blockers
amioderone
34
Q

What may indicated it is more of a vascular parkinsonism? (rather than PD)

A

Affects mainly lower limbs
rest tremor uncommon
Other signs of lesion eg spastivity, hemiparesis
poor levodopa response

35
Q

what is the features of drug induced parkinsonism

A

symmetrical
postural tremor
Other drug induced disorders may be present eg tardive dystonia, akathisia, orolingual dyskinesia

36
Q

What is essential tremor

A

Not really seen at rest
Symmetric, postural or kinetic tremor with high frequency
alcohol responsiveness

37
Q

what is SWEDDs

A 
Scans without evidence of dopaminergic deficit
Asymmetrical
At rest
No true bradykinesia
Characteristivs of dystonia
38
Q

What is multi system atrophy?

A

Dysautonimia +cerebellar disease+Parkinsonism

39
Q

What is hot cross bun sign

A

MRI shows cerebellar and pontine atrophy - multisystem atrophy

40
Q

What is progressive supranuclear palsy

A

symmetric akinetic rigid syndrome with predominantly axial involvement
gait imbalance prominent, rarely tremor

41
Q

what is fragile x-tremor ataxia syndrome

A

late onset neurodegenerative disorder in patients with an abnormal number of CGG repeats in the FMR1 gene
symtoms=ataxic gait, postural/intention tremor, variably parkinsonism, dysautonomia, cognitive decline of frontal type, peripheral neuropathy
slow disease progression

42
Q

What is MCP sign

A

middle cerebellar peduncles - FXTAS

Neurology (36 decks)

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