parkinsons Flashcards
What are the less common symptoms of parkinsons
Mask-like face Postural hypotension Trouble standing Trouble turning when walking Trouble turning in bed Vivid dreams Changes to writing Urinary retention Constipation Swallowing problems difficult stopping- fastint dementia later
What are the three main symptoms of PD?
Tremor at rest
Rigidity- resistance to movement
Bradykinesia eg slowness in initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive actions, such as finger or foot tapping) or
Hypokinesia (poverty of movement) — for example:
Reduced facial expression, arm swing, or blinking.
Difficulty with fine movements such as buttoning clothes and opening jars, or small, cramped handwriting (micrographia).
Slow, shuffling, festinating gait, or difficulty turning in bed.
What is the cause of parkinsons?
It is caused by degeneration of the dopaminergic pathways in the substantia nigra.
What can cause parkinsonisms apart from PD?
anti-psychotics (extra pyramidal SE), SSRIs, HD, LBD, wilsons disease, CJD, HIV, head injury, encephalitis, stroke (vascular)
What criteria is three or more needed to support PD diagnosis?
Unilateral onset. Rest tremor present. Progressive disorder. Persistent asymmetry affecting the side of onset most. Excellent response (70-100%) to L-dopa. Severe L-dopa-induced chorea. L-dopa response for five years or more. Clinical course of ten years or more. Hyposmia. Visual hallucinations.
What are the differentials for PD?
benign essential tremor, drug induced, HD, wilsons disease, CJD, dementia, LBD, Progressive supranuclear palsy. multiple system atrophy
What investigations are done for PD?
usually diagnosed off exaination alone but if abnormal for PD: CT, MRI if dont respond to L-dopa SPECT if tremor genetic test for HD syphilis and HIV screen ceruplasmin for wilsons
what two conditions are majorly associated with PD?
dementia and depression
What is the management for PD?
levodopa is good for symptomatic management -offer if symptoms affecting lifestyle
Monoamine-oxidase-B inhibitors (MAO-BIs) - selegiline, rasagiline.
Dopamine agonist. Cabergoline, pramipexole, ropinirole and rotigotine are effective. Initial treatment with an agonist is recommended in younger patients.
describe a benign essential tremor
Postural tremor: worse if arms outstretched
Improved by alcohol and rest
Titubation
Often strong family history