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Parkinson's Disease (Clinical Presentation (CLASSIC TRIAD (Rigidity -…
Parkinson's Disease
Key Facts
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Characterised by the triad of - rigidity, bradykinesia (slow to execute movement), resting tremor
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Aetiology
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Combination of:
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Environmental factors - pesticides, MPTP - found in illegal opiates
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Pathophysiology
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This results in the progressive degeneration of DOPAMINERGIC NEURONS from the pars compact of the substantia nigra in the midbrain that project to the striatum (caudate and putamen) of the basal ganglia
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Less dopamine means that the thalamus will be inhibited resulting in a DECREASE IN MOVEMENT and thus the symptoms of Parkinson's
Clinical Presentation
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Characteristic Parkinson's gait - stooped posture, small shuffling steps, reduced arm swing, narrow base
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Before motor symptoms develop (can be 7 years prior) - anosmia, depression/anxiety, aches, REM sleep disorders, urinary urgency, hypotension and constipation
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CLASSIC TRIAD
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Bradykinesia/hypokinesia
Slow to initiate movement and flow, low-amplitude excursions in repetitive actions
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Differential Diagnosis
Benign essential tumour (more common) - worse on movement and rare whilst at rest - treat with beta blockers, or anti-seizure/anti-epileptics
Multiple cerebral infarcts, Lewy body dementia, drug-induced, Wilson's disease, trauma and all dopamine antagonists
Treatment
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Balance problems, speech and Gai disturbance do not respond to medication thus physiotherapy is the mainstay treatment for these
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Diagnosis
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MRI head - initially normal but will show atrophy, also used to exclude tumours or normal pressure hydrocephalus (forget how to walk, enlarged ventricles, dementia)
Diagnosis is CLINICAL, based on history and examination
If any of these are present in EARLY PARKINSON's, they are a sign that they aren't Parkinson's
- Dementia
- Incontinence
- Symmetry
- Early falls