Parkinsons

Question 1

Key features of Idiopathic Parkinson’s Disease

Answer 1

Extrapyramidial features (e.g tremor, bradykinesia, rigidity)

Often unilateral (asymmetrical)

Question 2

Key features of Vascular Parkinsonism

Answer 2

Predominant lower body signs

Question 3

Key features of dementia with Lewy bodies

Answer 3

Triad of dementia, Parkinsonism and visual hallucinations (VH within first year of disease history)

Question 4

Key features of drug induced Parkinsonism

Answer 4

History of dopamine blocking drugs - neuroleptic or antipsychotics
Metoclopromide (nausea and indigestion)
Prochlorperazine (nausea and dizziness)

Question 5

Key features of Multi-systems atrophy

Answer 5

Prominent early autonomic features (hypotension, bladder instability)

Question 6

Key features of progressive supranuclear palsy

Answer 6

Early falls, truncal rigidity, vertical gaze palsy

Question 7

Key features of normal pressure hydrocephalus

Answer 7

Triad of dementia, gait disorder, and bladder instability

Question 8

Key features of cortical-basal degeneration

Answer 8

Asymmetrical Parkinsonism and dyspraxia

Question 9

Secondary features of idiopathic Parkinson’s disease

Answer 9

Secondary motor symptoms (hypomimia, hypophonia, gait abnormalities)

Non-motor features (REM sleep disturbance, anosmia)

Question 10

Secondary features of vascular Parkinsonism

Answer 10

Tremor less common, rigidity especially in the lower limbs, and hypomimia

Question 11

Secondary features of dementia with Lewy bodies

Answer 11

Prominent visual hallucinations, fluctuations in alertness

Question 12

Secondary features of drug induced Parkinsonism

Answer 12

Symmetrical rigidity, hypomimia

Question 13

Secondary features of multi-systems atrophy

Answer 13

Symmetrical Parkinsonism with autonomic complications

Question 14

Secondary features of Progressive supranuclear palsy

Answer 14

Reduction in mid brain volume on MRI (hummingbird sign)

Question 15

Secondary features of normal pressure hydrocephalus

Answer 15

Sign on imaging:

- dilation of ventricles out of proportion to sulcal atrophy

Question 16

Secondary features of cortico-basal degeneration

Answer 16

Cortical sensory deficit

Alien limb phenomenon

Question 17

Gait features in Parkinsonism

Answer 17

Stooped posture
Reduced/absent arm swing
Freezing of gait
Festinant/shuffling gait

Question 18

Epidemiology of Parkinson’s

Answer 18

10-20 per 100,000
Avg onset = 60
More common in men

Question 19

Diagnosis of Parkinsonian syndrome

Answer 19

Bradykinesia + 1 or more of the following:

Rigidity, tremor, postural instability

Question 20

Features to definitively diagnose Parkinson’s (3 or more of 8 required)

Answer 20

Unilateral onset
Resting tremor
Progressive disorder
Persistent asymmetry affecting side of onset most
Excellent response (70-10%) to Levodopa 
Severe levodopa induced chorea
Levodopa response for 5 years or more
Clinical course of 10 years or more

Question 21

Braak’s hypothesis

Answer 21

Disease starts in the PNS and progresses to CNS (first affected is the (PNS, Olfactory system, medulla = dorsal motor nuclei of vagal and glossopharyngeal nerves)
Caudal to rostral disease progression

Question 22

Appropriate first line treatment

Answer 22

Co-benoldopa (Madopar) 62.5mg TDS
Ropinirole 250mg TDS
Rasagaline 1mg OD (MAO-B inhib)