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3 NERVOUS SYSTEM > BASAL GANGLIA & PARKINSONISM > Flashcards

BASAL GANGLIA & PARKINSONISM Flashcards

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1
Q

Basal Ganglia is a MISNOMER

A

Basal Nuclei

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2
Q

Structural & Functional Components of BASAL GANGLIA

A
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3
Q

Parts of Substantia Nigra

A
  1. Pars Reticulata: Homologous to GP internus
  2. Pars Compacta
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4
Q

Wilson’s Pencil

A

Thin Myelinated (OR) Unmyelinated axons which are afferents & afferents passing through Straitum

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5
Q

⭐ Direct Pathway in Basal Ganglia does

⭐ Indirect Pathway in Basal Ganglia does

🧠⚡INdirect ⚡

A

⭐ Direct Pathway in Basal Ganglia does
🎯 Stimulates MOVEMENT

⭐ Indirect Pathway in Basal Ganglia does
🎯 INhibits MOVEMENT

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6
Q

Functions of BASAL GANGLIA

A

⭐ Inhibitory at REST ⭐

✨ TIMING & SCALING the intensity of movement
✨ Planning & Programming movement
✨ Cognitive component of Motor Activity
✨ Tone adjustment
✨ Movement Enhancer

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7
Q

2 EXTRA THINGS PRESENT in INDIRECT PATHWAY than DIRECT PATHWAY

A
  1. Globus pallidus Externus
  2. Subthalamus
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8
Q

Glutamate is EXCITATORY neurotransmitter, Released in BASAL GANGLIA by

A
  1. Cerebrum
  2. Subthalamus
  3. Thalamus
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9
Q

GABA is INHIBITORY neurotransmitter, Released in BASAL GANGLIA by

A

Corpus Straitum
✨ Caudate nucleus
✨ Putamen
✨ Globus pallidus

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10
Q

⭐ DOPAMINE is Released in BASAL GANGLIA

⭐ ACETYLCHOLINE is Released in BASAL GANGLIA

A

⭐ DOPAMINE is Released in BASAL GANGLIA
🎯 Substantia Nigra

⭐ ACETYLCHOLINE is Released in BASAL GANGLIA
🎯 Putamen

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11
Q

Direct pathway in BASAL GANGLIA

A
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12
Q

Indirect pathway in BASAL GANGLIA

A
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13
Q

Nigrostraital Pathway

A

Releases Dopamine
✨ D1 Receptor: Direct Pathway: Stimulate Movements

✨ D2 Receptor: Indirect Pathway: Inhibit Movements

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14
Q

Athetosis is DUE TO LESION in

A

Globus Pallidus

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15
Q

Athetosis

A

Slow
INVOLUNTARY
IRREGULAR
FORCEFUL
WRITHING movement
HANDS, ARM, NECK & FACE

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16
Q

Chorea is DUE TO LESION in

A

Caudate Nucleus
(OR)
Putamen

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17
Q

Chorea

A

Dancing like movement
Involuntary
Flicking movement
Hand, Face & Shouldera

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18
Q

Hemiballismus is DUE TO LESION in

A

Subthalamus
⬇️
Sudden Flailing movement of Entire limb

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19
Q

Parkinson’s disease is DUE TO LESION in

A

Substantia Nigra

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20
Q

Neurological Manifestation of WILSON DISEASE DUE TO

A

Copper Deposition in Lentiform nucleus

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21
Q

Only EXCITATORY NUCLEUS OF BASAL GANGLIA

A

Subthalamus

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22
Q

🚦DIFFERENTIAL DIAGNOSIS🚦 of HYPOKINETIC MOVEMENT

A
  1. Parkinson’s
  2. Non-Parkinson’s etiology
    ✨ Hypothyroidism
    ✨ Catatonia
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23
Q

⚡⚡ MOST COMMON NEURODEGENERATIVE DISEASE

⚡⚡ 2nd MOST COMMON NEURODEGENERATIVE DISEASE

⚡⚡ MOST COMMON SUBCORTICAL NEURODEGENERATIVE DISEASE

A

⚡⚡ MOST COMMON NEURODEGENERATIVE DISEASE
🎯 ALZHEIMER’S DISEASE

⚡⚡ 2nd MOST COMMON NEURODEGENERATIVE DISEASE
🎯 PARKINSON’S DISEASE

⚡⚡ MOST COMMON SUBCORTICAL NEURODEGENERATIVE DISEASE
🎯 PARKINSON’S DISEASE

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24
Q

Age of Parkinson’s presentation

A

≥ 65 yrs

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25
If age of presentation of Parkinson's DISEASE is ≤ 60yrs, known as
Familial Parkinson's Disease
26
⚡⚡ MOST COMMON CAUSE of FAMILIAL PARKINSON'S 🧬 MODE OF INHERITENCE 💉
PARK8 ⭐ AD ⭐ LRRK2 mutation
27
FAMILIAL Forms of PARKINSON'S
28
Function of Alpha Synuclein
Lipid Binding Protein ASSOCIATED with Synapses
29
Substantia Nigra is Pigmented DUE TO:
Presence of NEUROMELANIN Granules ⬇️ Synthesis of Dopamine
30
Lewy Body
Accumulation of Alpha Synuclein
31
Synuclein deposition occurs 1st in
Lower BRAINSTEM (MEDULLA) ⬇️ PONS ⬇️ MIDBRAIN ⬇️ SUBSTANTIA NIGRA
32
Prion like spread within Brain is ASSOCIATED with
PARKINSON'S DISEASE ✨ Alpha Synuclein aggregates can be released from 1 neuron & taken uup by another
33
Absent Swallow Tail Sign is seen in
MRI: PARKINSON'S DISEASE
34
MRI Signs of PARKINSON'S DISEASE
1. Loss of Pigmentation in SUBSTANTIA NIGRA 2. ABSENT SWALLOW TAIL SIGN 3. B/L HYPERINTENSE GREY MATTER on upper Midbrain
35
Lewy Bodies can be seen in
1. Other Pigmented nuclei in Brainstem 2. Dorsal Nucleus of Vagus 3. Nucleus BASALIS 4. Other Cortical ASSOCIATION Areaa
36
Primary & Secondary PARKINSON'S Disease 🧠⚡2° causes: We Will Have DPT² ViaL⚡
1. WILSON's disease 2. Whipple's DISEASE 3. Head Trauma: Dementia pugilistica 4. Drug induced 5. Post-encepahlitic 6. Toxins: Manganese, MPTP, CO, Cyanide 7. Tumour / Thyroid Function ⬇️ ⬇️ 8. Vascular 9. Liver Failure
37
Symptoms of PARKINSON'S DISEASE 🧠⚡Be SMART⚡
ASYMMETRICAL ➕ 1. Bending Forward (OR) Tilt 2. Shuffling Gait 3. Mask like facies 4. Akinesia / Bradykinesia 5. Rigidity 6. Tremors
38
Earliest Symptom of PARKINSON'S DISEASE
Tremor ⬇️ Akinesia ⬇️ Axial Skeleton: Gait & Posture ⬇️ Sleep, ANS, Sensory ⬇️ Cognitive Symptoms
39
Clinical Phenotypes of PARKINSON'S DISEASE
1. Tremor Predominant 🎯 Younger patient (60-70yrs) 🎯 BETTER Prognosis 🎯 SLOWER DISEASE PROGRESSION 2. Akinetic Rigid Syndrome 🎯 Older patient > 70yrs 🎯 POOR Prognosis 🎯 FASTER DISEASE PROGRESSION
40
⚡⚡ MOST COMMON Clinical Phenotype of PARKINSON'S DISEASE
Tremor Predominant
41
⚡⚡ MOST COMMON PRESENTING SYMPTOM OF PARKINSON'S DISEASE
Tremors
42
Charcteristic Features of TREMORS in PARKINSON'S DISEASE
✨ Pill Rolling Tremors 1. Resting Tremor 2. UL Distal 3. Frequency: 5-6 Hz 4. Asymmetrical: U/L ➡️➡️ B/L 5. Worsens with Emotional Stress 6. Disappears on VOLUNTARY ACTIVITY & SLEEP 7. Brought ON by concentration 8. Most patient t have Combination of Action ➕ Rest Tremors
43
Types of TREMORS
1. Resting Tremors 2. Intentional tremors or Kinetic 3. Postural
44
Frequency of different types of TREMORS 🧠⚡REPs increasing⚡
1. Resting Tremors in PD: 4-6Hz 2. Essential Tremors: 8-10Hz 3. Physiological Tremors: 12Hz
45
Progression of Involvement of Limb in Tremors of PARKINSON'S DISEASE
I/L arm ⬇️ I/L Leg ⬇️ C/L Leg ⬇️ C/L Arm
46
Difference between PD Tremor & Essential Tremors
47
✨ Relieving Factors for PARKINSON'S DISEASE TREMOR ✨ Relieving Factors for ESSENTIAL TREMOR
✨ Relieving Factors for PARKINSON'S DISEASE TREMOR 🎯 L-DOPA 🎯 Dopamine agonists 🎯 anticholinergic ✨ Relieving Factors for ESSENTIAL TREMOR 🎯 ALCOHOL 🎯 PROPRANOLOL 🎯 PRIMIDONE 🎯 TOPIRAMATE 🎯 GABAPENTIN 🎯 CLONAZEPAM
48
Target Site for DEEP BRAIN STIMULATION in: ⭐ PARKINSON'S DISEASE ⭐ DYSTONIA ⭐ DEPRESSION ⭐ OCD ⭐ ESSENTIAL TREMORS
⭐ PARKINSON'S DISEASE 🎯 SUBTHALAMUS 🎯 GPi ⭐ DYSTONIA 🎯 GPi ⭐ DEPRESSION 🎯 ANTERIOR LIMB OF INTERNAL CAPSULE 🎯 CINGULUM ⭐ OCD 🎯 ANTERIOR LIMB OF INTERNAL CAPSULE ⭐ ESSENTIAL TREMORS 🎯 VENTRAL INTERMEDIATE NUCLEUS
49
Wheel Chair Sign seen in
PARKINSON'S DISEASE ✨ Rising from Wheel Chair: Difficult
50
GLABELLAR TAP SIGN seen in
PARKINSON'S DISEASE 🎯 Repetitive Tapping (at 2Hz) over Glabella produces Sustained BLINK RESPONSE
51
Myerson's Sign
GLABELLAR TAP sigb
52
Characteristic features of BRADYKINESIA in PARKINSON'S DISEASE
1. Facial Hypomimia (Expressionless facies) 2. Automatic Movements ⬇️⬇️ (Arm Swinging) 3. Small Hand writing 4. Wheel Chair Sign 5. GLABELLAR TAP sign 6. Difficulty in tying Shoelaces, buttoning up & Difficulty in ROLLING OVER in Bed 7. Hypophonic Voice (Slow & Soft) Flat monotonus & stuttering
53
⭐ Narrow Based Gait seen in ⭐ Broad Based Gait seen in
⭐ Narrow Based Gait seen in 🎯 PARKINSON'S DISEASE ⭐ Broad Based Gait seen in 🎯 PARKINSON Plus syndrome 💎 Cerebellar disease
54
Abnormal Pull Test seen in
PARKINSON'S DISEASE ⬇️ Pt falls backward
55
Froment's sign seen in ⭐ Meaning
PARKINSON'S DISEASE ⭐ Activity induced ⬆️ in C/L Limb Rigidity
56
Rigidity vs Spasticity
57
Difference BETWEEN PARKINSON'S DISEASE DEMENTIA & LEWY BODY DEMENTIA
58
PARKINSON PLUS ➕ SYNDROME 🧠⚡PCM Do⚡
Group of disorder that presents with PARKINSONISM Features (BRADYKINESIA & RIGIDITY) but are different in underlying clinical manifestations & pathology 1. Progressive Supranuclear Palsy 2. Cortico-basal Degeneration 3. Multi-system Atrophy 4. Diffuse Lewy Body DEMENTIA
59
Steele Richardson Olszewski Syndrome
Progressive Supranuclear Palsy
60
Suspect PARKINSON plus syndrome if
1. No response to Levodopa 2. Absense of Rest Tremors 3. Severe & Early ANS features 4. Cortical abnormality: Apraxia 5. Supranuclear gaze palsy 6. Predominant Cerebellar (OR) Pyramidal findings 7. Early ONSET REPEATED FALLS 8. Symmetrical BRADYKINESIA 9. EARLY DEMENTIA & HALLUCINATION
61
UK BRAIN BANK CRITERIA is used to diagnose
Parkinson's disease
62
Synucleinopathies 🧠⚡P²REM = Love⚡
1. Parkinson's disease 2. Pure Autonomic Failure 3. REM Behavioural Disorders 4. Multi system atrophy 5. Lewy Body DEMENTIA
63
In PARKINSON'S & LEWY BODY DEMENTIA, Synuclein aggregates in In MULTI SYSTEM ATROPHY, Synuclein aggregates in
In PARKINSON'S & LEWY BODY DEMENTIA, Synuclein aggregates in 🎯 Neurons In MULTI SYSTEM ATROPHY, Synuclein aggregates in 🎯 Glial Cells
64
⭐ Hyper-phosphorylated Tau Proteins are aggregated in ⭐ Hypo-phosphorylated Tau Proteins are aggregated in
⭐ Hyper-phosphorylated Tau Proteins are aggregated in 🎯 ALZHEIMER'S DISEASE ⭐ Hypo-phosphorylated Tau Proteins are aggregated in 🎯 PICK'S DISEASE
65
SUBCORTICAL TAUPATHIES
1. Progressive Supranuclear Palsy 2. Corticobulbr Degeneration
66
TAUPATHIES 🧠⚡PNS C And D⚡
1. Progressive Supranuclear Palsy 2. Pick's disease 3. Post-encephalitic PARKINSON'S DISEASE 4. Pantothenate Kinase ASSOCIATED Degeneration 5. Niemann Pick DISEASE type C 6. SSPE 7. CBD 8. Chronic Traumatic Encephalopathy (Dementia Pugilistica) 9. ALZHEIMER'S disease 10. Down's Syndrome
67
🌸 TYPES of MSA Multi System Atrophy 🧠⚡ PAC⚡
1. MSA-P: PARKINSON like presentation 2. MSA-A: Autonomic Features Predominant 3. MSA-C: Cerebellar Features Predominant
68
Shy Dagger Syndrome
MSA-A
69
SHY DAGGER SYNDROME 🧠⚡SHY? Parked Cerebellum⚡
1. Systemic Atrophy 2. Hypotension 3. Y = Urinary Incontinence / Urgency ➕ other autonomic features 4. Symptoms of PARKINSON'S DISEASE 5. Cerebellum problems: Coordination & Speech
70
LEWY Body DEMENTIA 🧠⚡ Lewy has halLEWYcinations. Lewy is slowy. Lewy is sleepy. Lewy is slippy. lEwy also has an E ⚡ 🧠⚡ Lewy is slow-y, sleepy, slippy and sees things (halLEWYcinations)⚡
✨ Visual hallucinations are common ✨ Slow movements for Parkinson's disease ✨ REM sleep abnormalities like drowsiness. ✨ DLB is associated with frequent falls. ✨ eosinophilic intracytoplasmic alpha synuclein aggregates.
71
Essential TREMORS
More common in males Family history often present It's an action tremor (not resting) Tremor begins in hands > arms > head >> legs (very rarely are legs involved) Rx: 1) Non-selective beta-blocker (Propranolol)        2) Primidone (anticonvulsant) Alcohol improves the symptoms.
72
🧑🏻‍⚕️ Clinical Features of MSA
1. Cranio-cervical dystonia 2. High Pitched Dysarthria 3. Pyramidal involvement ➕ 4. Autonomic features ➕ 5. Cerebellar features ➕
73
Radiological findings of MSA
IN MSA-C 1. Cruciform Hyperintensity @ Pons 2. Hot cross Bun sign in MSA-P 3. PUtamen Ring Hyperintensity
74
PSP 🧠⚡BEEF HAFS⚡
1. Broad Based Gait 2. Extension Hypertonia: Retrocollis 3. Eyelid Apraxia: Down Gaze Palsy 4. Emotional Incontinence 5. Frequent Falls 6. Facial Dystonia: Procerus (OR) Surprise sign 7. Hummingbird (OR) Penguin Sign on MRI 8. Applause Sign ➕ 9. Frontal Release Sign ➕ 10. Spastic Dysarthria
75
PARKINSON plus syndrome with EARLY FREQUENT FALLS
PSP
76
Flexion Hypertonia seen in Extension Hypertonia seen in
Flexion Hypertonia seen in 🎯 PARKINSON'S DISEASE Extension Hypertonia seen in 🎯 PROGRESSIVE Supranuclear PALSY
77
Procerus sign (OR) Surprise sign seen in
Progressive Supranuclear Palsy
78
Applause sign ⭐ Seen in
When you ask to applause, the patient don't STOP, NORMAL person stops ⭐ Seen in: Progressive Supranuclear Palsy
79
How to differentiate BETWEEN Progressive Supranuclear Palsy & Pick's Disease
Applause test ➕ in PSP
80
Cause of development of HUMMINGBIRD SIGN on MRI
Atrophy of MID-BRAIN
81
Dysarthria: TYPES
1. FLACCID 2. SPASTIC 3. CEREBELLAR
82
Difference BETWEEN PSP & CBD on H&E
CBD: Tufted ASTROCYTES CBD: ASTROCYTE PLAQUES
83
PARKINSONISM Motor Features ➕ CORTICAL Features ➕ ➕ MRI: CORTICAL ATROPHY
Corticobasal Degeneration
84
🧑🏻‍⚕️ Clinical Features of CORTICOBASAL DEGENERATION
1. Apraxia, Agnosia 2. Alien Limb Phenomena 3. Asymmetrical DYSTONIC Contractions 4. Dystonia
85
Alien Limb Phenomena seen in ⭐meaning
CORTICOBASAL DEGENERATION ⭐ Without own's knowledge, limb assumes a position in space ⬇️ Doing something, you don't know about
86
Neuroprotective Drugs used in PARKINSON'S DISEASE
1. MAO-B ⛔ ✨ Selegeline 2. Glutamate antagonist ✨ Riluzole
87
Drugs causing PARKINSONISM 🧠⚡ NA FART⚡
1. Neuroleptics 2. Amiodarone 3. Flunarizine 4. Alpha Methyl DOPA 5. Reserpine 6. Tetrabenazine 7. Metoclopramide 8. Lithium 9. Cinnarizine
88
Treatment of PARKINSON'S DISEASE 🧠⚡ Cold SALAD⚡
89
Symptoms of PARKINSON'S that do NOT IMPROVE with Levodopa 🧠⚡CAP Falls ⚡
1. Cognitive impairment: DEMENTIA ➕ Sleep d/o 2. ANS Symptoms 3. Postural instability 4. Falls
90
Levodopa benefits which symptoms 🧠⚡TRAp ⚡
1. Tremors 2. Rigidity 3. BRADYKINESIA (OR) Akinesia
91
🤢😳SIDE EFFECTS🥴😵 of LEVODOPA
92
Peak Dose Dyskinesia with LEVODOPA
Choreiform movement, Athetosis & Ballismus 1. Young ♀️ with Severe Disease 2. With HIGHER Dose of Levodopa 3. Rhythmic contractions Predominant in Lower Limb
93
Wearing Off Phenomena
94
On Off Phenomena seen with
Levodopa ⬇️ Unpredictable fluctuations ✨ ON: Dyskinesia ➕ ✨ OFF: Dystonia
95
PISA SYNDROME seen in
Seen in PARKINSON'S DISEASE pt treated with LEVODOPA ✨ In OFF Phase

3 NERVOUS SYSTEM (40 decks)

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