Parkinsonism and Parkinson's Disease

Question 1

Where are the three main origins of movement disorders?

Answer 1

Corticospinal ie pyramidal
Basal Ganglia ie extrapyramidal
Cerebellum

Question 2

What kind of symptoms occur in a corticospinal tract lesion

Answer 2

Weakness

Spasticity

Question 3

What kind of symptoms occur in a basal ganglia lession

Answer 3

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

Hypokinetic e.g Parkinson’s

Question 4

What symptoms occur due to cerebellar lesions

Answer 4

DANISH
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech -dysarthria
Hypotonia

Question 5

What is dystonia

Answer 5

prolonged muscle spasms and abnormal postures

Question 6

What is chorea

Answer 6

fragments of movements flow irregularly from one body segment to another causing a dance-like appearance

Question 7

what is ballismus

Answer 7

high amplitude choreo form movements

Question 8

What is the parkinsonian syndrome

Answer 8

rigidity
akinesia/bradykinesia
resting tremor

Question 9

What is Parkinson’s disease?

Answer 9

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

Question 10

What is the neurohistological hallmark of Parkinson’s disease

Answer 10

Lewy bodies

Question 11

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

Answer 11

Loss of dopaminergic cells in substancia nigra

Question 12

What are the strongest risk factors for parkinson’s

Answer 12

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

Question 13

What may be protective of parkinsons

Answer 13

smoking
NSAIDs
high uric acid levels

Question 14

What are the motor symptoms of Parkinson;s

Answer 14

bradykinesia
rest tremor
rigidity
postural and gait impairement

Question 15

What is bradykinesia

Answer 15

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

Question 16

what is hypomimia

Answer 16

decreased facial expression and eyeblinking

Question 17

what is hypophonia

Answer 17

reduced voice volume

Question 18

what is micrographia

Answer 18

progressively smaller handwriting

Question 19

What are the characteristics of a resting tremor

Answer 19

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

Question 20

What kind of resting tremors are there

Answer 20

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

Question 21

when is a resting tremor best seen

Answer 21

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

Question 22

What is rigidity

Answer 22

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

Question 23

What is froment’s maneuver

Answer 23

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

Question 24

what kind of posture and gait occurs in parkinsonism

Answer 24

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

Question 25

what is camptocormia

Answer 25

extreme anterior tuncal flexion

Question 26

Name some non motor features of parkinson's

Answer 26

dementia, hallucinations, hyposmia, REM, constipation, depression

Question 27

What is myoclonus

Answer 27

a rapid involuntary twitching motion by a muscle group

Question 28

What is the disadvantage of dopamine functional imaging

Answer 28

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

Question 29

What investigations can be done if parkinsons disease is suspected

Answer 29

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

Question 30

What are the 'red flag' parkinsons presentations

Answer 30

``` 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 ```

Question 31

what are the common causes of parkinsonism

Answer 31

``` PD drug induced progressive supranuclear palsy Lewy body dementia Vascular parkinsonism ```

Question 32

what are the less common causes of parkinsonism

Answer 32

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

Question 33

what drugs can cause parkinsonism

Answer 33

``` prochlorperaziine metoclopramide antipsychotics calcium channel blockers amioderone ```

Question 34

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

Answer 34

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

Question 35

what is the features of drug induced parkinsonism

Answer 35

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

Question 36

What is essential tremor

Answer 36

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

Question 37

what is SWEDDs

Answer 37

``` Scans without evidence of dopaminergic deficit Asymmetrical At rest No true bradykinesia Characteristivs of dystonia ```

Question 38

What is multi system atrophy?

Answer 38

Dysautonimia +cerebellar disease+Parkinsonism

Question 39

What is hot cross bun sign

Answer 39

MRI shows cerebellar and pontine atrophy - multisystem atrophy

Question 40

What is progressive supranuclear palsy

Answer 40

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

Question 41

what is fragile x-tremor ataxia syndrome

Answer 41

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

Question 42

What is MCP sign

Answer 42

middle cerebellar peduncles - FXTAS