parkinsons Flashcards
causes of parkinsonism
idiopathic parkinsons, parkinsonian plus, degenerative, secondary- vascular, drugs, post encephalitic, genetic
what is it caused by
Lewy bodies and neuronal cell death in substantia nigra (loss of dopaminergic neurones)
key features
bradykinesia, tremor, rigidity UNILATERAL
other features
gait abnormalities, GOOD RESPONSE TO LEVODOPA, anosmia, postural hypotension, urinary urgency, constipation, micrographia
type of tremor
pill rolling. resting tremor.
what are the types of rigidity
lead pipe which is stiffness on passive movement and not velocity dependent. cogwheel rigidity is stiffness occuring with tremor
what diagnostic tool can be used
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
treatment of PD
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
other drugs used in PD
sergiline, rasagiline- MAOB; amantadine; anticholinergics; apomorphine
what is entacapone
COMT- which can be added in
examples of dopamine agonists
cabergoline
what drugs can induce parkinsonism
typical and atypical antipsychotics, GI prokinetics eg metoclopramide
cognitive and psych changes in PD
cognitive impairment in late stage PD. may develop into dementia. visual hallucinations on treatment and psychosis. cholinesterase inhibitors may be helpful
symptoms of progressive supranuclear palsy (PSP)
Parkinsonism, postural instability with falls, vertical supranuclear gaze palsy, pseudobulbar palsy, dementia
what is seen deposited in PSP
tau protein
how can differentiate PSP from PD
not a good response to levodopa and symmetrical in onset
what is different in Multiple system atrophy (MSA) from PD
autonomic symptoms eg bladder, bp; and ataxia in addition to Parkinsonism
what is seen pathologically in MSA
alpha- synuclein positive glial cytoplasmic inclusions
what is seen in corticobasilar degeneration
alien limb phenomenon (hand moves without person being aware or having any control over it), myoclonus, dementia
what occurs with Parkinsonian plus syndromes
very progressive, only sometimes responds to levodopa, usually causes death within a decade
red flag symptoms suggesting one of the Parkinsonian plus syndromes
symmetrical onset and absence of tremor; levodopa unresponsiveness, early falls (within the first year), additional neurological features
what should be excluded in any patient
wilsons disease
what is wilsons disease
copper deposition in the basal ganglia, cornea, liver, intellectual impairment, reversible neurological damage. check serum Cu and caeruloplasmin. treat with chelating agent penicillamine
what are the symptoms of essential tremor
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
what is the tremor in ET
postural (eg when holding cutlery) or action, differentiating it from PD which is resting
what treatments can be used in ET
often no treatment is necessary. B blocker (propranolol), primidone, gabapentin
what treatment will make any tremor worse
sympathomimetics (salbutamol)
