Parkinsons Flashcards
(22 cards)
Key features of Idiopathic Parkinson’s Disease
Extrapyramidial features (e.g tremor, bradykinesia, rigidity)
Often unilateral (asymmetrical)
Key features of Vascular Parkinsonism
Predominant lower body signs
Key features of dementia with Lewy bodies
Triad of dementia, Parkinsonism and visual hallucinations (VH within first year of disease history)
Key features of drug induced Parkinsonism
History of dopamine blocking drugs - neuroleptic or antipsychotics
Metoclopromide (nausea and indigestion)
Prochlorperazine (nausea and dizziness)
Key features of Multi-systems atrophy
Prominent early autonomic features (hypotension, bladder instability)
Key features of progressive supranuclear palsy
Early falls, truncal rigidity, vertical gaze palsy
Key features of normal pressure hydrocephalus
Triad of dementia, gait disorder, and bladder instability
Key features of cortical-basal degeneration
Asymmetrical Parkinsonism and dyspraxia
Secondary features of idiopathic Parkinson’s disease
Secondary motor symptoms (hypomimia, hypophonia, gait abnormalities)
Non-motor features (REM sleep disturbance, anosmia)
Secondary features of vascular Parkinsonism
Tremor less common, rigidity especially in the lower limbs, and hypomimia
Secondary features of dementia with Lewy bodies
Prominent visual hallucinations, fluctuations in alertness
Secondary features of drug induced Parkinsonism
Symmetrical rigidity, hypomimia
Secondary features of multi-systems atrophy
Symmetrical Parkinsonism with autonomic complications
Secondary features of Progressive supranuclear palsy
Reduction in mid brain volume on MRI (hummingbird sign)
Secondary features of normal pressure hydrocephalus
Sign on imaging:
- dilation of ventricles out of proportion to sulcal atrophy
Secondary features of cortico-basal degeneration
Cortical sensory deficit
Alien limb phenomenon
Gait features in Parkinsonism
Stooped posture
Reduced/absent arm swing
Freezing of gait
Festinant/shuffling gait
Epidemiology of Parkinson’s
10-20 per 100,000
Avg onset = 60
More common in men
Diagnosis of Parkinsonian syndrome
Bradykinesia + 1 or more of the following:
Rigidity, tremor, postural instability
Features to definitively diagnose Parkinson’s (3 or more of 8 required)
Unilateral onset Resting tremor Progressive disorder Persistent asymmetry affecting side of onset most Excellent response (70-10%) to Levodopa Severe levodopa induced chorea Levodopa response for 5 years or more Clinical course of 10 years or more
Braak’s hypothesis
Disease starts in the PNS and progresses to CNS (first affected is the (PNS, Olfactory system, medulla = dorsal motor nuclei of vagal and glossopharyngeal nerves)
Caudal to rostral disease progression
Appropriate first line treatment
Co-benoldopa (Madopar) 62.5mg TDS
Ropinirole 250mg TDS
Rasagaline 1mg OD (MAO-B inhib)
