parkinsonism
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Introduction
A neurologic disorder usually resulting from dopamine deficiency as a result of degenerative, vascular or inflammatory changes in the basal ganglia. It is characterized a resting tremor, muscular rigidity, bradykinesia, a droopy posture & mask-like facies. It may occur as a side effect of antipsychotic medications or as a feature of several neurodegenerative disorders.
Etiology
- idiopathic Parkinson's disease (most common etiology)
- multiple system atrophy
- progressive supranuclear palsy
- corticobasal ganglionic degeneration
- diffuse Lewy body disease
- vascular parkinsonism
- hereditary disorders
- Wilson's disease
- Huntington's disease
- juvenile paralysis agitans
- L-dopa responsive dystonia
- Hallervorden-Spatz disease (pantothenate kinase-2 deficiency)
- Dentatorubral-pallidoluysian atrophy
- Machado-Joseph-Azorean disease (SCA 3)
- Fahr's disease
- Leigh's disease
- spinocerebellar ataxias
- fragile X tremor/ataxia syndrome
- familial amyotrophy-dementia-parkinsonism
- other neurodegenerative disorders sometimes associated with parkinsonism
- Alzheimer's disease
- Pick's disease (frontotemporal dementia)
- Creutzfeldt-Jakob disease (Prion disease)
- Neuro-acanthocytosis (chorein mutation)
- neuro-metabolic disorders
- secondary parkinsonism
- head trauma (dementia pugilistica {professional boxing})
- post-anoxia
- normal pressure hydrocephalus (NPH)
- metabolic disorders
- hypoparathyroidism
- hypothyroidism, rare, resolves with treatment
- paraneoplastic syndrome
- hepatocerebral degeneration
- basal ganglia calcification (rare)
- post-viral encephalitis (encephalitis lethargica)
- brain tumors (rare)
- toxins
- pharmacologic agents: (drug-induced parkinsonism)
- antipsychotics:
- haloperidol (Haldol)
- fluphenazine (Prolixin)
- aripiprazole* (NEJM)[9]
- antiemetics
- reserpine
- alpha-methyldopa (rare)
- lithium carbonate (rare)
- antipsychotics:
* change to lamotrigine (NEJM)[9]
Clinical manifestations
- bradykinesia[5]
- rigidity
- resting tremor
- postural instability
- freezing gait
- stooped posture
- masked facies
- hypophonia[5]
- cognitive impairment may be an early sign of impending parkinsonism[8]
* Red flags for atypical forms of parkinsonism[5]
- dysautonomia
- orthostatic hypotension, urinary incontinence, sweating dysfunction
- abnormal eye movements
- early cognitive impairment, early onset dementia
- visual hallucinations (not provoked by medications)
- early postural instability & falls (within 1st year)
- gait ataxia +/- cerebellar signs (dysmetria, nystagmus)
- symmetric or markedly asymmetric involvement
- rapid onset & stepwise deterioration -> vascular parkinsonism
- lack of response to sinemet (most important red flag)[5]
Complications
- weight loss in Parkinson's disease is associated with dementia, dependency & mortality[7]
More general terms
More specific terms
- drug-induced parkinsonism
- parkinson plus syndrome
- Parkinson's disease (paralysis agitans, PD)
- post-encephalitic parkinsonism
- vascular parkinsonism
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Lang & Lazano NEJM 339(15):1044-53 1998
- ↑ Bronstein J, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ Abdo WF, Borm GF, Munneke M, Verbeek MM, Esselink RA, Bloem BR. Ten steps to identify atypical parkinsonism. J Neurol Neurosurg Psychiatry. 2006 Dec;77(12):1367-9. Epub 2006 Jul 17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16847047
Burn DJ. Ten steps to identify atypical parkinsonism. J Neurol Neurosurg Psychiatry. 2006 Dec;77(12):1299. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17110742 - ↑ 5.0 5.1 5.2 5.3 5.4 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Aerts MB, Esselink RA, Post B, van de Warrenburg BP, Bloem BR. Improving the diagnostic accuracy in parkinsonism: a three- pronged approach. Pract Neurol. 2012 Apr;12(2):77-87 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22450452
- ↑ 7.0 7.1 Cumming K, Macleod AD, Myint PK, Counsell CE. Early weight loss in parkinsonism predicts poor outcomes: Evidence from an incident cohort study. Neurology 2017 Nov 28; 89:2254 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29079685 Free PMC Article
- ↑ 8.0 8.1 Darweesh SKL, Wolters FJ, Postuma RB et al. Association between poor cognitive functioning and risk of incident parkinsonism: The Rotterdam Study. JAMA Neurol 2017 Dec 1; 74:1431 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973176
- ↑ 9.0 9.1 9.2 NEJM Knowledge+