Flashcards in Parkinsonism Deck (37)
What are some environmental risk factors for Parkinson's.
Prior head injury, pesticides, rural living, well drinking, B blockers,
What are some environmental factors that decrease your risk of Parkinson's?
Tobacco smoking, Coffee, NSAIDs, Ca2+ blockers, Alcohol
What are some genetic risk factors for Parkinson's.
+ve Family History
What genes are related to Parkinson's?
LRRK2 - autosomal dominant
PARKIN - Autosomal recessive
What does management and treatment involve in Parkinson's?
No curative treatment entirely symptomatic relief.
What is the main aim of symptomatic relief?
To increase intracerebral dopamine concentration or stimulate dopamine receptors
What are the mainstay drugs for symptomatic treatment of Parkinsons?
MAO B inhibitors
What is Levodopa?
A precursor to dopamine used to treat bradkinetic symptoms of parkinsonism.
List some common side effects of Levodopa/ Dopamine Agonists
When should dopamine agonists be avoided?
In cognitive impairment as increased risk of hallucination.
If someone with Parkinsonism presents with dementia like symptoms what is the treatment?
Give an example of an acetylcholinesterase inhibitor used in Parkinson's.
If someone with Parkinson's presents with depression what is the treatment?
If someone with parkisnons presents with psychosis what is the treatment?
Clozapine - Cognitive features
Quetiapine - Hallucination and Delusions only
If someone with parkinsons presents with sleep disorders what is the treatment ?
If someone with parkinsons presents with fatigue what is the treatment?
List some red flags in a patient with parkinsons.
Severe axial limb involvement
Dysfunction within Spinal columns i.e corticospinal
Where is predominantly affected in vascular parkinsons?
Describe presentation of vascular Parkinsonism.
Rest tremor is uncommon
Sign of brain lesion I.e spasticity hemiparesis
Poor levodopa response
Lower limbs affected
How is vascular parkinsons diagnosed?
Structural brain imaging involved.
What is the key thing to note when a diagnosis of drug induced parkinsons is possible?
Onset after exposure to a new drug
Describe drug induced Parkinson's.
Coarse symmetrical postural tremor
Improvement upon withdrawal of drug
What is a common cause of degenerative Parkinson's?
Multi System Atrophy
When does multi system atrophy present?
What are the main features of Multi system atrophy ?
Describe the presentation of multi system atrophy.
Hyperflexia - extensor plantar
Jerky postural tremor
Severe dysarthria dysphonia
What is dysarthria?
Muscles required to speak are paralysed so unable to formulate words properly.
What is dysphonia?
Abnormal voice often hoarse
How does Multi system atrophy respond to levodopa?