3 - PARKINSONISM Flashcards
(82 cards)
1
Q
Atypical Parkinsonism
A
Sporadic, Heredodegenerative, Atypical presentations of common diseases
2
Q
Conditions under sporadic parkinsonism
A
- multiple system atrophy
- lewy body dementia
- corticobasilar degeneration
- progressive supranuclear palsy
3
Q
Conditions under heredodegenerative parkinsonism
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- wilson disease
- X-linked dystonia parkinsonism
4
Q
Secondary parkinsonism include
A
- vascular parkinsonism
- normal pressure hydrocephalus
5
Q
Primary parkinsonism include
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- Parkinson’s Disease
- Atypical parkinsonism
6
Q
Cardinal Signs of Parkinsonism
A
- Rigidity
- Bradykinesia
- Tremor
- Postural instability
7
Q
Involuntary motion with decreased muscle power
A
Parkinson’s
8
Q
Most commonly affected in parkinson’s
A
Basal Ganglia
9
Q
Major cause of disability in parkinson’s; Slow movement c diff in initiating & loss of automatic movement
A
bradykinesia
10
Q
Types of rigidity
A
- Lead-pipe
- Cogwheel
- Froment Sign
- Flexed posture
11
Q
Rigidity that has resistance that is velocity dependent during passive motion
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Lead-pipe
12
Q
Rhythmic brief increase in resistance during passive movement
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Cogwheel
13
Q
Passive limb rigidity inc while another limb is in active motion
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Froment sign
14
Q
Most common presenting symptom in parkinson’s
A
Resting tremor
15
Q
4/sec tremor of thumb & fingers, present in 1/2 of PD pts
A
Classic pill-rolling tremor
16
Q
Normal for pull test
A
2 steps
17
Q
Shuffling gait, loss of balance that is improved by sensory guidance
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freezing phenomenon
18
Q
Used to diagnose Parkinson’s
A
MDS-PD Criteria
19
Q
Prevalence of Parkinson’s
A
M>F
20
Q
Loss of darkly pigmented cells in the SNPc
A
Neuropathology of Parkinson’s
21
Q
Depigmentation correlates with the death of what?
A
- dopaminergic neuromelanin-containing neurons (SNPc)
- Nonadrenergic neurons (Locus Ceruleus)
22
Q
What produces the cardinal motor sx in PD
A
decrease in dopaminergic signaling
23
Q
Hallmark of Parkinson’s
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Lewy Body Pathology
24
Q
primary structural component of lewy bodies
A
a-synuclein
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pathologic protein aggregates
Lewy Bodies
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inctracytoplasmic inclusions consisting of granular & fibrillar core c surrounding halo within neuronal cell bodies
Lewy Body Pathology
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Used to assess lewy body distribution
Braak Staging
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Dorsal motor nuclei of vagal N & anterior olfactury structures leading to olfactory loss, autonomic dysfunction & constipation
Stage 1
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Pts at this stage present c motor sx and are diagnoses
Stage 3
30
Worsening motor Sx c emotional disturbances
Stage 4
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Worsening motor Sx c cognitive changes
Stage 5
32
Affective impairment, anxiety, & sleep disturbances
Stage 2
33
High-level caffeine consumption & cigarette smoking __ risk of PD
decrease
34
Most potent treatment for PD
Levodopa
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Tx that inhibits peripheral decarboxylase
Carbidopa or Benserazide
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Delay need for levadopa before intaking MAO B inhibitors
~9 mos
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Anti-dyskinesia medicine with anti-cholinergic & anti-glutaminergic effects
Amantadine
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Surgical Treatments for PD
Ablative & Deep Brain Stimulation
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Substantia nigra damage d/t vascular diseases or syndromes that closely resembles PD d/t atherosclerotic white matter damage
Vascular Parkinsonism
40
Parkinsonism with mostly LE affectations c Sx such as shuffling gait, freezing, and/or falling
vascular parkinsonism
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MRI results usually seen in vascular parkinsonism
Changes in substantial white matter in B cerebral hemispheres
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Manifestations of vascular parkinsonism that is different from PD
- no tremors
- signs and sx more on lower extremity
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Triad of normal pressure hydrocephalus
Ataxia, urinary incontinence, dementia
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Gait pattern in NPH
short steps but not shuffling as there is momentary clearance of feet with each step
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Pathology for NPH
inc resistance to CSF outflow resulting in enlarged ventricles & abnormal CBF. Pressure exerted by brain parenchyma inc, leading to inc water content
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Tx for NPH
VP shunt
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Hepatolenticular degeneration
Wilson disease
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The great mimic
wilson disease
49
brown discoloration near the limbus of cornea d/t copper deposition in descemet's membrane
Kayser-fleischer ring
50
Condition c acute to chronic hepatopathy, hemolytic anemia, renal tubular changes, kayser-fleischer ring, cerebral damage, along c neurological sx
wilson disease
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fixity of facial muscles c mouth agape
grinning/vacuous smile
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Motor disorders in wilson disease
bulbar muscles, spread caudally
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A progressive condition mostly seen in filipino men with ancestry from panay island
X-Linked Dystonia Parkinsonism
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Other names for XDP
- DYT 3 dystonia
- Lubag
55
onset of XDP
- 12-64, most evidently seen in 30s to 40s
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High-intensity in T2
- caudate & putamen atrophy
- Ex vacuo dilation of lat ventricles
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MSA-P
Parkinsonism predominant
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Striatonigral degeneration
MSA-P
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Olivopontocerebellar degeneration; predominant cerebellar ataxia
MSA-C
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Parkinsonism + Autonomic disorders c. loss of mediolateral horn cells & pigmented nuclei of brainstem
MSA-A
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Shy-drager syndrome
MSA-A
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Dystonia of lower fascial muscles
Anterocollis
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Histologic hallmark of MSA
Glial Cytoplasmic inclusions
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Hot cross bun sign
Pons, seen in MSA-C
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Hyperintensities in pontocerebellar tracts seen in __
T2
66
abnormally increase in T2 linear rim surrounding putamen
putaminal rim sign
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What is abnormal in MSA-P as seen in imaging procedures
putaminal signal
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structures mostly atrophied in MSA-C
Cerebellum & brainstem (Olivary nuclei & MCP)
69
Parkinsonism most commonly seen in 60 y/o; 45-75 y/o
Progressive Supranuclear palsy
70
Pt presents c imbalance, frequent falls c preserved consciousness, neck dystonia, ocular palsies
Progressive supranuclear palsy
71
facial muscle that has tonic contraction in progressive supranuclear palsy
procerus
72
gradual stiffening & extension of neck
camptocormia
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what is atrophy of the dorsal mesencephalon, particularly the superior colliculus & red nuclei, called?
Mouse Ear/Morning Glory sign
74
selective atrophy of dorsal midbrain best seen in mid sagittal view
Hummingbird sign
75
thick & often composed of single strands wether twisted or parallel arrangement; seen in progressive supranuclear palsy
Neurofibrillary tangles
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L-Dopa has ______ benefit in PSP
slight & unsustained
77
"Alien Limb"
corticobasal ganglionic degeneration
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progressive asymmetrical extrapyramidal rigidity c signs of corticospinal disease & ideomotor apraxia
corticobasal degeneration
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ballooned & chromatolytic neurons c eccentric nuclei, most commonly seen in the post frontal & parietal lobes
Neuronal Achromasia
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diffused involvement of cortical neurons c LB inclusions
Lewy Body Dementia
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Signs and Sx of lewy body dementia
- parkinsonism
- fluctuating behavior & cognitions
- recurrent hallucinations
- REM sleep behavior disorder
- extreme sensitivity to neuroleptics
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Condition c little to no NFTs & Amyloid plaques present
LB Dementia
