Parkinsons Dse Flashcards by Jerome Quimson

Is characterized by the pathologic degeneration of brainstem nuclei, usually dopaminergic cells of substantia nigra. It is also due to hyperactivity of the cholinergic neurons in the caudate nucles

Parkinsons dse

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Most common presenting symptoms of PD

Resting tremor

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Pill rolling tremor, how many Hz

3-5hz

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Smooth resistance to passive movement that is independent of velocity

Lead pipe rigidity

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Ratcheting through the ROM

Cogweel rigidity

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Slumped over and forward with protracted shoulders and flexed hips and knees, what posture is this?

Simian posture

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Slowness of motion

Bradykinesia

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Bradykinesia affecting facial expression is termed as?

Masked fascies (hypomimia)

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Most important risk factor associated with death for PD patients

Dysphagia

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Describe the speech of PD patients

Rapid and monotonous and have a low volume with poor articulation and inappropriate periods of silence

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What is the term for the hand writing of PD patients described as small and crampled

Micrographia

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Autonomic dysfx of PD patients

Increase salivation
Drooling
Orthostasis
Increased perspiration
Constipation
Hyperreflexic bladder with incontinence
Dysphagia
Erectile dysfx

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Differential diagnosis of PD

Progressive supranuclear palsy
Shy dragger syndrome
Multisystem degeneration

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Has early vertical eye movement abnoramlities

Progressive supranuclear palsy

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Has early autonomic failure

Shy dragger syndrome

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Has babinski sign, ataxia, and peripheral neuropathy

Multisystem degeneration

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Positive prognosticating factor for PD

Rigidity
Early tremor
Family history

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Negative prognosticating factor for PD

Bradykinesia
Postural instability
Gait dysfunction
Cognitive deficits
Late age of onset

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Keystone of parkinson disease treatment; dopamine replacement

Levadopa

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Levadopa is typically administered with a peripheral decarboxilase inhibor such as?

Carbidopa

Adverse effect of levadopa

Motor fluctuations - inc. tremor and bradykinesia at end dose cycle. Commonly in younger patients
Dyskinesias- chorea, painful dystonia, and myoclonus
Psychiatric symptoms- florid psychosis

Dopamine agonist such as:

Pergolide
Pramipexole
Ropinerole

Adverse effects of dopamine agonist

Nausea
Vommiting
Orthostatic hypotension
Psychiatric symptoms

Progressive, adult onset AUTOSOMAL DOMINANT disorder that is associated with cell loss with in a specific subset of neurons in the caudate nucleus and putamen; diagnosed at 3rd to 4th decade of life, life expectancy after diagnosis is 20 years

Huntington disease

Cardinal features of huntington:

Involuntary movements Dementia Behavioral changes

Most primary cause of mortality in huntington disease

Pneuomonia and cardiovascular problems

Hallmark of huntington dse

Chorea,excessive,abrupt,irregular spontaneous voluntary movements

Most common psychologic dysfunction encountered, with mania, psychotic personality and obsessive compulsive disorder

Depression

Medical treatment for huntington dse

Xenazine

Most common hereditary ataxia

Friedrich ataxia

Other neurodegenerative processes that have ataxia as predominant feature

Wilsons dse Refsum dse Spinocerebellar dse

An AUTOSOMAL RECESSIVE PROGRESSIVE disorder with the presentation of limb and gait ataxia with diminished muscle stretch reflexes, joint position, and vibratory appreciation

Friedrich ataxia

Hereditary spastic paraparesis is aka?

Familial spastic paraplegia or strumpell-Lorrain syndrome

Cardinal features of spastic hereditary paraparesis

Asymmetric lower limb spastic paraparesis and extensor plantar response

Onset of hereditary spastic paraparesis

Weakness of tibialis anterior, hamstrings, and iliopsoas muscle Hypertonicity, spasticty, and hyperreflexia can occur s weakness Leg stiffness and spasm that occur more commonly at night, after exertion or in cold weather

Uncomplicated spastic paraparesis only type

Age of onset before 35 years

Complicated paraparesis plus other neurologic findings

Age of onset is after 35 years

3 classifications according to mode of inheritance

Autosomal dominant Autosomal recessive X linked

Characterized by muscle contraction resulting to twisting, turning, and posturing

Dystonia

Drug of choice for generalized dystonia

Baclofen and clonazepam

Dystonia affecting two or more adjacent body parts of the body

Segmental dystonia

Most common dystonia

Cervical dystonia

Blepharospasm is treated by?

Botulinium toxin

It is a constellation of symptoms including tic disorders and comorbin

Tourette syndrome

4 diagnostic criteria for tourette syndrome

1. both multiple and one or move vocal tics must be present at som time during the illness 2. tics occur many times a day over more than 1 year, during which there must not have been a tic free period of more than 3 consecutive months 3. age of onset is younger than 18 4. Disturbance is not caused by direct physiologic effects of a substance or general medical conditions

Defined as involuntary, sudden, repetitive, rapid, non rhytmic, stereotyped movements or vocalizations

Tics

Hallmark feature of tourette

Tics

Category of tics

Simplex Complex Motor Phonic