OHCM - Parkinsonism Flashcards Preview

Neurology > OHCM - Parkinsonism > Flashcards

Flashcards in OHCM - Parkinsonism Deck (23):
1

Parkinson's clinical triad:

1. Tremor.
2. Rigidity/incr. tone.
3. Bradykinesia/hypokinesia.
4. Shuffling gait.

2

Tremor:

1. Worse at rest; often "pill-rolling" of thumb over fingers.
2. 4-6 cycles/sec (SLOWER than cerebellar tremor).
3. Distinguish from "essential tremor", which is symptomatic postural and action tremor of the upper limbs and head.

3

Rigidity/incr. tone:

Rigidity + tremor = "cogwheel rigidity" felt by the examiner during rapid pronation/supination.

4

Bradykinesia/hypokinesia:

Slow to initiate movement and slow, low-amplitude excursions in repetitive actions, eg decr. blink rate, monotonous hypophonic speech, micrographia.

5

Gait:

1. Decr. arm swing.
2. Festinance (shuffling steps with flexed trunk, as if chasing one's centre of gravity).
3. Freezing at obstacles or doors.
4. Expressionless face (hypomimesis).

6

Parkinsonism - Etiology:

1. Idiopathic PD.
2. Drugs (neuroleptics, metoclopramide, prochlorperazine).
3. Rarely: trauma/boxing, encephalopathy post-flu, manganese or copper toxicity (Wilson), HIV, Parkinson's-plus syndromes.

7

Idiopathic PD:

1. Mutations in FbXo7 may be important in disrupting mitophagy, the process CNS cells use to eliminate faulty mitochondria.
2. PINK1 and Parkin also play a role.

8

Idiopathic PD - Presentation:

Bradykinesia/hypokinesia + one or more of:
1. Tremor at rest (one side worse).
2. Postural instability +/- rigidity.

9

Idiopathic PD - Other signs may be subtle:

1. Poor decoding of the emotional content of speech (prosody).
2. Poor executive functioning.
3. REM sleep disorders.

10

Idiopathic PD - Non-motor features:

1. Sense of smell reduced.
2. Constipation.
3. Visual hallucinations.
4. Frequency/urgency.
5. Dribbling of saliva.
6. Depression and dementia.

11

Idiopathic PD - A devastating symptom:

Poor simultaneous motor and cognitive functions can lead to freezing while walking.

12

Idiopathic PD - Typical age at onset:

65yrs.

13

Idiopathic PD - Prevalence:

0.6% - 60-64.
3.5% - 85-89.
(Europe)

14

Pathology:

Mitochondrial DNA dysfunction causes degeneration of dopaminergic neurons in the substantia nigra pars compacta (associated with Lewy bodies), hence decr. striatal dopamine levels.

15

Rx - Neuropsychiatric complications:

1. Depression, dementia, psychosis --> May reflect progression or SE.
2. Try SSRIs for depression.
3. Distinguish drug-induced psychosis (consider reducing DA-agonist doses) from disease progression (try atypical antipsychotics, eg quetiapine, olanzapine).

16

Levodopa is used combined with ...?

A dopa-decarboxylase inhibitor, such as Madopar (co-beneldopa) or Sinemet (co-careldopa).

17

5 Parkinson's-plus syndromes:

1. Progressive supranuclear palsy (PSP - Steele-Richardson-Olszewski syndrome).
2. Multiple system atrophy (MSA - Shy-Drager).
3. Lewy body dementia.
4. Cortico-basal degeneration.
5. Vascular Parkinsonism.

18

Progressive supranuclear palsy (PSP - Steele-Richardson-Olszewski syndrome):

1. Early postural instability + VERTICAL gaze palsy +/- Falls.
2. Rigidity of trunk > in limbs.
3. Symmetrical onset.
4. Speech + Shallowing problems.
5. Little tremor.

19

Multiple system atrophy (MSA - Shy-Drager):

1. Early autonomic features --> Impotence/incontinence, postural hypotension.
2. Cerebellar + pyramidal signs.
3. Rigidity > tremor.

20

Lewy body dementia:

Fluctuating cognition with VISUAL hallucinations + EARLY dementia.

21

Cortico-basal degeneration (CBD):

1. Akinetic rigidity involving one limb.
2. Cortical sensory loss (eg astereognosis).
3. Apraxia (even autonomous interfering activity by affected limb - the ALIEN LIMB phenomenon).

22

Vascular parkinsonism:

2-5% of PD:
1. Pyramidal signs (legs).
2. Diabetic/hypertensive patient who falls or has gait problems, (eg ataxia (no festination).

23

James Parkinson (...-...)?

1755-1824.