Please enable JavaScript.
Coggle requires JavaScript to display documents.
Parkinsonism - Coggle Diagram
Parkinsonism
Idiopathic Parkinson's Disease
Extrapyramidal features
Tremor
Bradykinesia
Rigidity
Asymmetry of clinical signs (often unilateral at initial presentation)
Secondary motor symptoms
Hypomimia
Hypophonia
Gait abnormalities
Camptocormia
Loss of arm swing
Impaired turning
Festinant gait
Freezing gait (exacerbated by obstacles)
Ways to overcome this e.g. counting out loud
Reduced blinking rate
Micrographia
Non-motor features
REM sleep disturbance
Anosmia
Managed with levodopa or dopamine adonist and physical activity/ therapy
Gradual onset
Vascular parkinsonism
Predominant lower body signs
Tremor less common
Rigidity escpecially in lower limbs
Hypomimia
~50% respond to levodopa
Gradual or step-wise
Progressive supranuclear palsy (PSP)
Early falls
Truncal rigidity
Vertical gaze palsy
Reduction in midbrain volume on MRI
"Hummingbird sign"
Early SALT review and supportive measures
Cortico-basal degeneration
Asymmetrical parkinsonism
Dyspraxia
Cortical sensory deficit
Alien limb phenomenon
Symptomatic management only (does not respond well to levodopa)
Drug induced parkinsonism
History of dopamine blocking drugs (antipsychotics, metoclopramide)
Symmetrical rigidity and hypomimia
Managed by reducing or stopping drug if possible
Multi-systems atrophy
Prominent early autonomic features (hypotension, bladder instability)
Symmetrical parkinsonism with autonomic complications
Managed with levodopa and supportive treatments
Normal pressure hydrocephalus
Triad of dementia, fait disorder and bladder instability
Signs of normal pressure hydrocephalus on neuro-imaging
Diagnostic lumbar puncture and CSF removal, then ventriculo-peritoneal shunt
Dementia with Lewy bodies
Triad of dementia, parkinsonism and visual hallucinations
Fluctuations in alertness