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Parkinsonian Disorder

Parkinsonian Syndrome


Presentation

  • In the present study, the sensitivity for the diagnosis of PSP was 84.2%.[academic.oup.com]
  • Of these, another 69 were excluded: 24 patients who upon examination did not present with clear parkinsonian symptoms or who presented with drug-induced parkinsonism, as well as 45 patients (18.7%) who did not have a sufficient bone window for an adequate[peerj.com]
  • In the present study, the NPR was available from 1964 to 2009.[karger.com]
  • Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinson’s disease, but that generally do not respond well to drug treatment with levodopa.[hopkinsmedicine.org]
  • Since SPGR images are more widely available and faster to acquire than DTI, we focus on these for the present work.[journals.plos.org]
Hypophonia
  • Patients often have one or several of the following signs: Tremor, or rhythmic unintentional movement Rigidity, or stiffness Bradykinesia, or a sense of slowing down in general Hypophonia, or softening of the voice Micrographia, or small handwriting Flexed[med.umich.edu]
  • Other common symptoms include: mask face, stooped posture, increased flexor tone, drooling, shuffling, seborrhea, orthostasis, decreased blinking, soft voice (hypophonia). It is often asymmetrical (especially at the onset). 26-4.[dartmouth.edu]
Falling
  • Backward falls are common and may occur during the early course of the disease. PSP is not usually associated with tremor, unlike Parkinson’s disease.[hopkinsmedicine.org]
  • Impaired eye movement (downward gaze - damage to oculomotor nucleus) Prominent stare Slowed vertical saccades Falls, often backwards Neck hyperreflexia Hummingbird Sign in MRI due to atrophy of the midbrain tegmentum, with a relatively preserved pons.[quizlet.com]
  • […] in symptoms such as significant orthostatic hypotension (falling blood pressure when standing), erectile dysfunction and incontinence early in the disease.[verywell.com]
  • Such balance problems in Parkinson’s disease are associated with a tendency to list or fall backward (retropulsion); in fact, a light push can cause the individual with Parkinson’s disease to continue stepping backward or to even fall down.[apdaparkinson.org]
  • Other symptoms include repeated falls, fainting spells, delusions, sleep disorders and depression.[med.umich.edu]
Fatigue
  • Women who complained of fatigue and sleepiness were more often diagnosed with depression than sleep apnea.[clinicaladvisor.com]
  • Fatigue Fatigue is a complex symptom of Parkinson’s disease that is not fully understood. It is known, however, that fatigue is significantly associated with depression and sleep disorders.[apdaparkinson.org]
  • Fatigue. Many people with Parkinson's disease lose energy and experience fatigue, and the cause isn't always known. Pain. Many people with Parkinson's disease experience pain, either in specific areas of their bodies or throughout their bodies.[mayoclinic.org]
  • FATIGUE AND SLEEP DISTURBANCE Fatigue is present in one-third of patients with Parkinson disease at diagnosis, and is associated with severity of illness.[aafp.org]
  • MD, FRCP Professor, Clinical Ageing Reserach Unit Campus for Ageing and Vitality, Newcastle University Newcastle Upon Tyne, UK The defining feature of parkinsonism is bradykinesia, or slowness with decrement and degradation of repetitive movements (“fatigue[movementdisorders.org]
Difficulty Walking
  • Progressive supranuclear palsy Symptoms of PSP include: Difficulty walking Balance problems Recurrent falls that are often backwards Stiffness of the muscles – particularly the neck and trunk muscles Difficulty moving the eyes up and down – this may not[ftdtalk.org]
  • walking and frequent falls early in the course of the disease.[med.umich.edu]
Mask-like Facies
  • […] characterized by insidious onset of rhythmical muscular tremors at rest (pill-rolling tremor; 4-6 Hz), paucity and slowness of movement (hypokinesia, bradykinesia) and generalized rigidity (cogwheel and lead-pipe rigidity), festinant gait, stooped posture, mask-like[medical-dictionary.thefreedictionary.com]
Hypomimia
  • In addition to a general slowness of movement, the bradykinesia of Parkinson’s disease is typically demonstrated by a reduced or mask-like expression of the face (hypomimia or facial masking), a decreased blink rate of the eyes, and problems with fine[apdaparkinson.org]
Facial Muscle Rigidity
  • Facial muscle rigidity can also partly or completely account for the "masked facies."[dartmouth.edu]
Tremor
  • The tremor (shaking body parts) of Parkinson disease appears during rest of the limb and disappears or weakens during active movement. Additionally, Parkinson's disease cause walking problems and slow movements.[medical-dictionary.thefreedictionary.com]
  • PSP is not usually associated with tremor, unlike Parkinson’s disease.[hopkinsmedicine.org]
  • Aspirin & recurrent ischemic stroke risk Take Quiz Intracerebral hemorrhage management via blood pressure control Take Quiz AHA/ASA Guidelines: Adult stroke rehabilitation & recovery Take Quiz Quiz Transcranial focused ultrasound & refractory essential tremor[mdedge.com]
  • We found that clinical presentation (presence of tremor-dominant disease) did not seem to affect disease detection in the NPR.[karger.com]
Bradykinesia
  • […] certain antipsychotic drugs (e.g. perazine, phenothiazines, butyrophenones and depot preparations); characterized by insidious onset of rhythmical muscular tremors at rest (pill-rolling tremor; 4-6 Hz), paucity and slowness of movement (hypokinesia, bradykinesia[medical-dictionary.thefreedictionary.com]
  • Bradykinesia Greek for “slow movement,” bradykinesia is a frequent symptom of Parkinson’s disease and related movement disorders.[apdaparkinson.org]
  • Bradykinesia and rigidity are additive in hindering movement and are usually present together. Bradykinesia is, however, not dependent on or necessarily proportional to rigidity, and vice versa.[dartmouth.edu]
  • Subtle “bradykinesia” has been reported to occur in the “normal elderly” population, but this may reflect a non-specific slowness rather than bradykinesia as defined above.[movementdisorders.org]
Postural Instability
  • Cerebellar ataxia was assessed using the Parkinson’s plus scale [ 34 ] and postural instability using the Postural Instability and Gait Disorder (PIGD) scale [ 35 ] ( Table 1) .[journals.plos.org]
  • Postural Instability More pronounced in the later stages, postural instability includes the inability to maintain a steady, upright posture or to prevent a fall.[apdaparkinson.org]
  • Patients with the parkinsonian presentation typically have an asymmetrical tremor, bradykinesa, rigidity and postural instability. Men often develop impotence; both men and woman often experience urinary urgency and incontinence.[pdcenter.neurology.ucsf.edu]
  • Terminology To be diagnosed with Parkinson’s Disease , someone must have two of four symptoms: rigidity, bradykinesia (slow movement), tremor, or postural instability.[brainsupportnetwork.org]
Resting Tremor
  • Parkinsonism is a broad term that refers to a group of neurological conditions that present with combinations of motor problems including resting tremor, rigidity, flexed posture, “freezing”, loss of postural reflexes and slowness of movement.[verywell.com]
  • The cardinal motor signs and symptoms of PD, include the characteristic clinical picture of resting tremor, rigidity, akinesia, and impairment of postural reflexes. It evolves slowly.[movementdisorders.org]
  • Typically beginning in the sixth or seventh decade of life, it is characterized by the unilateral onset of resting tremor in combination with varying degrees of rigidity and bradykinesia.[clevelandclinicmeded.com]
Micrographia
  • Patients often have one or several of the following signs: Tremor, or rhythmic unintentional movement Rigidity, or stiffness Bradykinesia, or a sense of slowing down in general Hypophonia, or softening of the voice Micrographia, or small handwriting Flexed[med.umich.edu]
  • Having trouble turning over in bed and slow, small handwriting (micrographia) are other signs of bradykinesia.[apdaparkinson.org]
  • […] greater than extremity rigidity; absence of resting tremor and prominent autonomic dysfunction; poor response to carbidopa/levodopa 1 , 9 Features that increase the likelihood of Parkinson disease include those associated with bradykinesia, such as micrographia[aafp.org]

Workup

  • Blood-based NfL might consequently be included in the diagnostic workup of patients with parkinsonian symptoms in both primary care and specialized clinics.[lup.lub.lu.se]
  • If the twins remained suspects after the second screening, they were invited to a clinical workup (phase III, see below).[karger.com]
  • Blood tests for NfL might be included in the diagnostic workup of patients with parkinsonian symptoms in both primary care and specialized clinics.[neurologytimes.com]
  • "This easily accessible biomarker of axonal degeneration may improve the diagnostic workup of patients with parkinsonian symptoms in specialized clinics as well as in primary care settings."[medpagetoday.com]

Treatment

  • […] optionsInsomnia assessment & treatment options Take Quiz Insomnia: Prevalence & patient population Take Quiz Insomnia assessment & treatment options Take Quiz Quiz Lennox-Gastaut syndrome classification Take Quiz Lennox-Gastaut syndrome development Take[mdedge.com]
  • Atypical Parkinsonism Treatment Although research is deepening medical understanding of these disorders, atypical Parkinsonian disorders are progressive and as yet there are no treatments that effect a cure.[hopkinsmedicine.org]
  • RBD was fully or substantially controlled with nightly clonazepam treatment in 89% (24/27) of patients in both groups. Thus, RBD can be the heralding manifestation of Parkinson's disease in a substantial subgroup of older male RBD patients.[neurology.org]
  • Pleuropulmonary and retroperitoneal fibrosis What are some dopaminergic treatments? Non-ergot Dopamine Agonists e.g.[quizlet.com]

Prognosis

  • […] clinically probable Parkinson disease Take Quiz MDS criteria for Parkinson disease diagnosis Take Quiz Treating Parkinson disease Take Quiz Pathogenesis and pathology of Parkinson disease Take Quiz Muscle strength & Parkinson disease Take Quiz Diagnosis & prognosis[mdedge.com]
  • What is the prognosis for Wolff-Parkinson-White syndrome? The prognosis for Wolff-Parkinson-White syndrome is excellent. Discussion with your physician can help navigate the treatment options that are available.[medicinenet.com]
  • Urinary Biomarker of Parkinson Disease Identified By Dinko Kranjac, PhD, Medical Editor To date, there are no validated biomarkers to independently assess Parkinson Disease diagnosis and prognosis, or to measure disease severity.[psychiatryadvisor.com]
  • They do not respond as well to dopaminergic treatments and generally have a worse prognosis compared to typical Parkinson’s disease.[movementdisorders.org]
  • Similarly, in studies of prognosis, PD cases cannot be followed from disease onset, since this is unknown.[karger.com]

Etiology

  • […] disease Take Quiz Eye movement abnormalities in Parkinson’s disease Take Quiz Olfaction & Parkinson’s disease risk Take Quiz Comorbidities in Parkinson’s disease Take Quiz Differentiation of PD from atypical parkinsonian disorders: NfL protein Take Quiz Etiology[mdedge.com]
  • The etiology of parkinsonian disorders is complex, and the causative factors are largely unknown [ 1 ]. Diagnoses are primarily clinical as there are no diagnostic biomarkers.[karger.com]
  • Research on prodromal symptoms of Parkinson’s disease (PD), including olfactory impairment and RBD, helps dissect disease etiology in this open access review by Honglei Chen in: J. Parkinsons Dis. , Vol 8:1, 2018.[journalofparkinsonsdisease.com]
  • Pathological diagnosis of genetic subtypes offers the prospect of distinguishing different mechanistic trajectories with a common mutational etiology, differing outcomes from varying allelic bases, and those disease-associated variants that can be used[nature.com]
  • Back to Top Conclusion The understanding of the etiology and neurobiology of PD continues to evolve.[clevelandclinicmeded.com]

Epidemiology

  • References de Lau LM, Breteler MM: Epidemiology of parkinson’s disease. Lancet Neurol 2006;5:525–535. Sorensen HT, Sabroe S, Olsen J: A framework for evaluation of secondary data sources for epidemiological research. Int J Epidemiol 1996;25:435–442.[karger.com]
  • […] stroke subtypes Take Quiz Thrombectomy & intravenous thrombolysis for stroke management Take Quiz Stroke and risk of familial late-onset Alzheimer disease Take Quiz Strokelike episodes in MELAS mitochondrial syndrome Take Quiz Poststroke depression epidemiology[mdedge.com]
  • […] biology • Neuroanatomy • Neurophysiology/electrophysiology • Neuropharmacology • Neuropsychology • Neuroimaging • Neurotoxicology • Clinical phenomenology • Surgical and pharmacological treatment • Transplantation studies • Relationship with aging • Epidemiology[journals.elsevier.com]
  • In an epidemiologic study of patients with parkinsonism, Schrag et al (2000) found that 65% had PD 18% had drug-induced parkinsonism 7% had vascular parkinsonism 6% had atypical but non-specific features 2.5 % had progressive supranuclear palsy 2% had[pdcenter.neurology.ucsf.edu]
  • Epidemiology [ 4 ] Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Blood biomarkers of brain injury Take Quiz Evaluating severe brain injury Take Quiz Defining and evaluating concussion and severe brain injury Take Quiz Neurogenic Orthostatic Hypotension Quiz Syncope in neurogenic orthostatic hypotension Take Quiz Pathophysiology[mdedge.com]
  • Advancing Pain Management: Human Studies By Tori Rodriguez, MA, LPC Research on monogenic disorders has made vital contributions to all aspects of medical care, including our understanding of pain pathophysiology.[psychiatryadvisor.com]
  • Pathophysiology Although the exact cause of MSA evades understanding, many pathophysiologic mechanisms have been uncovered. Iron and ferritin levels appear to be increased in the substantia nigra and striatum.[emedicine.medscape.com]
  • P values of Results Patient characteristics We allocated patients who were eventually diagnosed with essential tremor (ET) in the group of parkinsonism, because of the pathophysiologic resemblance with PD ( Fekete & Jankovic, 2011 ; Louis & Ottman, 2013[peerj.com]
  • Because it is reversible and not progressive or fatal, very little is known of the pathophysiology.[dartmouth.edu]

Prevention

  • […] of episodic migraine with NSAIDs and other therapies Take Quiz AAN guidelines: Prevention of episodic migraine in adults Take Quiz AAN guidelines: Evaluation and management of driving risk in dementia Take Quiz AAN Guidelines: Treatment of chorea in[mdedge.com]
  • This is encouraging news as the need for a reliable, accurate and affordable biomarker is essential in order to make real headway towards a cure or at least a drug regime which could prevent progression (if we could diagnose PD before any damage becomes[eastmidlands-rsn.org]
  • Can Wolff-Parkinson-White syndrome be prevented? Wolff-Parkinson-White syndrome cannot be prevented, but can be treated in the vast majority of people.[medicinenet.com]
  • Prevention Because the cause of Parkinson's is unknown, proven ways to prevent the disease also remain a mystery.[mayoclinic.org]
  • They are unable to make the appropriate kinetic-postural adjustment necessary to prevent them from falling.[dartmouth.edu]

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