parkinsons

Question 1

causes of parkinsonism

Answer 1

idiopathic parkinsons, parkinsonian plus, degenerative, secondary- vascular, drugs, post encephalitic, genetic

Question 2

what is it caused by

Answer 2

Lewy bodies and neuronal cell death in substantia nigra (loss of dopaminergic neurones)

Question 3

key features

Answer 3

bradykinesia, tremor, rigidity UNILATERAL

Question 4

other features

Answer 4

gait abnormalities, GOOD RESPONSE TO LEVODOPA, anosmia, postural hypotension, urinary urgency, constipation, micrographia

Question 5

type of tremor

Answer 5

pill rolling. resting tremor.

Question 6

what are the types of rigidity

Answer 6

lead pipe which is stiffness on passive movement and not velocity dependent. cogwheel rigidity is stiffness occuring with tremor

Question 7

what diagnostic tool can be used

Answer 7

DaT scan- dopamine transporter imaging. assess extent of nigrostriatal loss can be used to distinguish PD from other causes of tremor but cant be used to distinguish between PD and other akinetic eg drug induced

Question 8

treatment of PD

Answer 8

levodopa- combined with co beneldopa or carbidopa to reduce peripheral adverse effects. dopamine agonists- used in combination or monotherapy with younger patients with mild-mod

Question 9

other drugs used in PD

Answer 9

sergiline, rasagiline- MAOB; amantadine; anticholinergics; apomorphine

Question 10

what is entacapone

Answer 10

COMT- which can be added in

Question 11

examples of dopamine agonists

Answer 11

cabergoline

Question 12

what drugs can induce parkinsonism

Answer 12

typical and atypical antipsychotics, GI prokinetics eg metoclopramide

Question 13

cognitive and psych changes in PD

Answer 13

cognitive impairment in late stage PD. may develop into dementia. visual hallucinations on treatment and psychosis. cholinesterase inhibitors may be helpful

Question 14

symptoms of progressive supranuclear palsy (PSP)

Answer 14

Parkinsonism, postural instability with falls, vertical supranuclear gaze palsy, pseudobulbar palsy, dementia

Question 15

what is seen deposited in PSP

Answer 15

tau protein

Question 16

how can differentiate PSP from PD

Answer 16

not a good response to levodopa and symmetrical in onset

Question 17

what is different in Multiple system atrophy (MSA) from PD

Answer 17

autonomic symptoms eg bladder, bp; and ataxia in addition to Parkinsonism

Question 18

what is seen pathologically in MSA

Answer 18

alpha- synuclein positive glial cytoplasmic inclusions

Question 19

what is seen in corticobasilar degeneration

Answer 19

alien limb phenomenon (hand moves without person being aware or having any control over it), myoclonus, dementia

Question 20

what occurs with Parkinsonian plus syndromes

Answer 20

very progressive, only sometimes responds to levodopa, usually causes death within a decade

Question 21

red flag symptoms suggesting one of the Parkinsonian plus syndromes

Answer 21

symmetrical onset and absence of tremor; levodopa unresponsiveness, early falls (within the first year), additional neurological features

Question 22

what should be excluded in any patient

Answer 22

wilsons disease

Question 23

what is wilsons disease

Answer 23

copper deposition in the basal ganglia, cornea, liver, intellectual impairment, reversible neurological damage. check serum Cu and caeruloplasmin. treat with chelating agent penicillamine

Question 24

what are the symptoms of essential tremor

Answer 24

bilateral, fast, low amplitude, mainly in the upper limbs but can affect head and voice sometimes. usually starts early in life and is slowly progressive but rarely results in severe disability

Question 25

what is the tremor in ET

Answer 25

postural (eg when holding cutlery) or action, differentiating it from PD which is resting

Question 26

what treatments can be used in ET

Answer 26

often no treatment is necessary. B blocker (propranolol), primidone, gabapentin

Question 27

what treatment will make any tremor worse

Answer 27

sympathomimetics (salbutamol)