Neuro - conditions Flashcards
(9 cards)
PD - Extra exam
- Bradykinesia (by opening/closing hand & in foot tapping)
- Gait
- Glabellar tap not reliable’
- Gaze palsies (PSP) & cerebellar/UMN (MSA)
- Assess for seborrhoea/seborrhic dermatitis (autonomic dysfx)
- Micrographia
- Postural BP
- Cognitive (minimental)
PD - causes of Parkinsonism
- Idiopathic (PD)
- Drugs: Methyldopa, Metoclopramide, Chlorpromazine, Prochlorperazine, Na Valproate
- Parkinson Plus: PSP, MSA, CBD (+ LBD)
- Tumours (of basal ganglia, giant frontal meningioma)
- Normal Pb hydrocephalus
- Post encephalitis
- Toxins (CO, manganese)
- Wilsons dis
- Anoxic brain dis
PD - pathophys
Neurodeg dis of older adults
Degeneration of substantia nigra & pathways
Disrupts dopaminergic neurotransmission (w/ loss of lewy bodies)
PD - Dementia
Late in disease of ~20% pts
Within 1 yr of motor sx = LBD
PD - diff w/ Parkinsonism
PD asymmetric (Parkinsonism & parkinson-plus symmetrical)
PD has slower progression (Parkinsonism can be rapid)
PD responds to levodopa (Parkinsonism doesnt)
Parkinson-plus signs absent in PD
Parkinson-plus syndromes
MSA: autonomic failure, cerebellar dysfxn, UMN sx (MSA-P, -C, -A)
PSP: abN vertical→horizontal saccades, falls (axial rigidity), speech, rapid
CBD: higher cortical abN - limb apraxia (alien limb), myoclonus
PD - ix
Clinical dx
Brain imaging can exclude other dx
SPECT shows some fx but doesn’t distinguish PD/Park-plus (reduced 18-F uptake in contralateral putamen)
PD - Pharm Rx
Dopaminergic
1. Levodopa: use w/ peripheral dopa decarboxylase inhibitors to prevent peripheral metabolism to dopamine.
- S/E: N+V, post hypoTN, motor fluctuations, confusion (but less hallucin)
- Most effective for motor but SHORT t½
2. Dopamine agonists (Caberg, bromocript, pergolide / Pramipex, Rotiogine)
Either erg or non-ergolide agonists - can be patch.
3. MAO-B inh
But can metabolise to amphetamine w/ cog S/E (hallucin), ?neuroprotect
- Anticholinergics (help reduce tremor but hallucin)
- COMT-inhibitors (Catechol-O-methyl transferase)
- slow L-dopa metabolism, so more dyskinesia but less off - Apomorphine (Subcut)
- Amantidine (weak NDMA antagonist, psychosis)
PD - manage psychosis assoc w/ Rx drugs
- Withdraw non Levodopa drugs (except dopamine agonists if able)
- if persists on lowest L-dopa dose…
- Atypical antipsychotic eg
- CLOZAPINE
- or Quetiapine / Olanzepine
- If severe, ECT
- (Avoid risperidone)
