Stiff Salesman Flashcards
68 y.o male retired salesman. Slowness/difficulty using right arm began three years ago. Tremor in right arm and leg 2.5 years ago. thoughts?
some short of degenerative process (the fact that its one sided leans more toward degenerative then neoplastic)
What are some features on examination of this patient with parkinson’s disease?
Mask Facies (Expressionless/emotionless interpreted as a sad demeanor)
Hypophonic voice (low talker)
4-5 Hz tremor noted in the right arm and leg
Cog-wheel rigidity in all limbs, right >left
Low finger-nose, heel shin
Proximal weakness in thighs
slow and shuffling gait with small strides
lack of right arm swing (stage 1)
use small steps to turn
unable to raise from chair without assistance
difficulty initiating movement (akinesia)
postural instability
Parkinson’s disease: describe in one sentence
chronic, progressive disorder resulting from dopaminergic cell loss in the substantia nigra pars compacta.
what are some classical symptoms of a patient with parkinson’s disease.
resting tremor
akinesia
rigidity
loss of postural reflexes
Describe the type of midbrain lesion that occurs in parkinson’s patients
Degenerative, central, left and right lesion
What additional tests are done with parkinson’s patients to confirm the dx?
PET scan–> reveals decreased dopamine activity in the basal ganglia of the brain
what ares some drug treatments for a patient with parkinson’s disease?
dopamine agonists, L-Dopa, COMT inhibitors, MAO-B inhibitors.
what are surgical options for a parkinson’s patient?
Most common: Bilateral Stereotaxic Surgical Lesions of STN (reduced the excitatory drive on the GPi/SNr thereby reducing the inhibitory drive on the thalamus)
other options include: Surgical lesion of the GPi or thalamus or deep brain stimulation
What are some side effects if a patient is treated with too much L-DOPA?
psychosis (Excessive dopamine)–>they will state very vivid dreams
parkinson’s disease treatments are mainly just symptomatic based
what is the function of the direct pathway?
facilitate movement by stimulating cells in thalamus (SNc modulates movement through stimulation of the direct pathway and inhibition of the indirect pathway)
