Parkinsonian Disorder (Parkinsonian Syndrome)


Presentation

musculoskeletal
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  • respiratoric
    Hypophonia
    • 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]
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  • neurologic
    Tremor
    • 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]
    • Just because you have a tremor, does not mean you have Parkinson’s disease. Likewise, and further complicating the matter, not all patients with Parkinson’s have tremors.[verywell.com]
    Bradykinesia
    • 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]
    • Parkinson's disease is a movement disorder characterised by [ 1 ] : Tremor at rest Rigidity Bradykinesia The diagnosis is almost entirely based on clinical examination.[patient.info]
    • Clinically, it presents with bradykinesia cerebellar ataxia autonomic dysfunction pyramidal signs The term "multiple system atrophy" encompasses the three presentations of the illness that have overlapping clinical and pathological findings: striatonigral[pdcenter.neurology.ucsf.edu]
    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]
    • 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]
    • Parkinson disease (PD) is a neurological malady that causes tremors, bradykinesia, muscle rigidity, and postural instability. It affects about 1-2% of adults over the age of 60. Idiopathic Parkinson disease is more commonly seen in males.[clinicaladvisor.com]
    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]
    Dysarthria
    • The dysarthria observed in patients with MSA tends to be hypokinetic. Those with cerebellar features present with gait and limb ataxia, ataxic dysarthria, and sustained gaze-evoked nystagmus. They also tend to develop saccadic pursuit movements.[emedicine.medscape.com]
    • Most of these patients have early gait difficulty and there is often a significant dysarthria early in the course. Voluntary vertical gaze is also affected very early in the course.[dartmouth.edu]
    • […] beneficial, 11 , 20 it may help patients maintain family, social, and work roles and improve safety and motor function, and should be offered to those having difficulty performing tasks of daily living. 11 Many patients who have the disease develop dysarthria[aafp.org]
    Akinesia
    • 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]
    • […] antiparkinsonian drugs Spinocerebellar ataxias (usually type 2 or 3) Usually first manifests with imbalance and poor coordination Responds poorly to antiparkinsonian drugs Other disorders Cerebrovascular disease Manifests with rigidity and bradykinesia or akinesia[msdmanuals.com]
    • […] and targets being assessed for treatment using focused ultrasound include: Parkinsonian tremor – target in the thalamus (thalamotomy) Parkinsonian dyskinesia – target in the globus pallidus (pallidotomy) or subthalamic nucleus Parkinsonian tremor or akinesia[fusfoundation.org]
    Poor Coordination
    • coordination Responds poorly to antiparkinsonian drugs Other disorders Cerebrovascular disease Manifests with rigidity and bradykinesia or akinesia (akinetic-rigid syndrome) that predominantly involves the lower extremities, with prominent gait disturbance[msdmanuals.com]
    • It can cause poor coordination, slurred speech, problems with breathing, difficulty swallowing, and constipation . Parkinson's medications may provide some relief. Viral parkinsonism.[everydayhealth.com]
    Cogwheel Rigidity
    • May 1, 2014 The diagnosis of Parkinson disease (PD) is based on the observation of a constellation of motor abnormalities (bradykinesia, tremor at rest, cogwheel rigidity, postural instability) and the exclusion of other secondary causes of parkinsonism[psychiatrictimes.com]
    • The excess copper can lead to the formation of a copper- dopamine complex, which leads to the oxidation of dopamine to aminochrome. [22] The most common manifestations include bradykinesia , cogwheel rigidity [23] and a lack of balance. [24] Paraneoplastic[en.wikipedia.org]
    Micrographia
    • […] 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]
    Shuffling Gait
    • Can cause problems with slowness, shuffling gait and thinking problems. Head CT or MRI may be helpful in determining this.[nwpf.org]
    • Falling is a common problem for parkinsonian patients because of the combination of their rigid/bradykinetic shuffling gait and the postural adjustment deficit.[dartmouth.edu]
    Pill Rolling Tremor
    • You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor. One characteristic of Parkinson's disease is a tremor of your hand when it is relaxed (at rest). Slowed movement (bradykinesia).[mayoclinic.org]
    • The tremor tends to be postural, irregular, and jerky, unlike the typical pill-rolling tremor of idiopathic parkinsonism. The dysarthria observed in patients with MSA tends to be hypokinetic.[emedicine.medscape.com]
    Hand Tremor
    • Typically, the tremor begins on one side of the body, usually in one hand. Tremors can also affect t ... How common is Parkinson disease? Parkinson disease affects more than 1 million people in North America and more than 4 million people worldwide.[hon.ch]
    Extrapyramidal Symptoms
    Abnormal Involuntary Movement
    • However, its early use is associated with earlier development of dyskinesias (abnormal involuntary movements). Dopamine agonists such as pramipexole (Mirapex) and ropinirole (Requip) directly stimulate dopamine receptors.[aafp.org]
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  • Face, Head & Neck
    Facial Muscle Rigidity
    • Facial muscle rigidity can also partly or completely account for the "masked facies."[dartmouth.edu]
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  • Entire body system
    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]
    • Falls . Contractures. Bowel and bladder disorders. Prognosis Slowly progressive with a mean duration of fifteen years. Severity, however, varies widely.[patient.info]
    • Early problems with balance, falls and/or freezing of gait. Early problems with autonomic function such as orthostatic hypotension (lightheadedness when standing from low blood pressure.) Earlier speech and swallowing problems.[nwpf.org]
    Fatigue
    • Women who complained of fatigue and sleepiness were more often diagnosed with depression than sleep apnea.[clinicaladvisor.com]
    • 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]
    • They should be distinguished from fasciculations and from myokymia (such as that often occurs in eye muscles with fatigue). These disorders come in many varieties.[dartmouth.edu]
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  • Jaw & Teeth
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  • Workup

    Treatment

    Prognosis

    Complications

    Alzheimer Disease
    • disease & circadian rhythm disturbance Take Quiz Midlife triglycerides & amyloid beta pathology risk Take Quiz Prevalence of preclinical Alzheimer’s disease Take Quiz Statins & Alzheimer’s disease risk Take Quiz Alzheimer’s disease & UPSIT Take Quiz[mdedge.com]
    • DLB is second only to Alzheimer’s disease as a cause of dementia in the elderly, and it most commonly affects patients in their 60s.[hopkinsmedicine.org]
    • Genetics of Alzheimer's disease . Adv. Genet. 87 , 245–294 (2014). 51. Seidel, K. et al. First appraisal of brain pathology owing to A30P mutant alpha-synuclein . Ann. Neurol. 67 , 684–689 (2010). 52. Zarranz, J.J. et al.[nature.com]
    • They might look more like Alzheimer’s Disease, frontotemporal dementia, or stroke. To be diagnosed with Alzheimer’s Disease , someone must have progressive dementia including memory loss.[brainsupportnetwork.org]
    • […] alzheimer's, alzheimer disease, dementia, presenile alzheimer, alzheimer type dementia, dementia in alzheimer's disease (disorder), alzheimer's disease (disorder), alzheimers dementia, dementia of the alzheimer's type, sporadic alzheimer's disease) ,[hpscreg.eu]
    Parkinson's Disease
    • Clinical, neuropathological and genotypic variability in SNCA A53T familial Parkinson's disease. Variability in familial Parkinson's disease . Acta Neuropathol. 116 , 25–35 (2008). 61. Yamaguchi, K. et al.[nature.com]
    • Parkinson’s disease & GCH1 mutation Take Quiz Cardiovascular risk & statin use in patients with Parkinson’s disease Take Quiz Parkinson’s disease: Effect of diet & exercise Take Quiz Parkinson’s disease and parkinsonism incidence Take Quiz Parkinson disease[mdedge.com]
    • At the time of RBD diagnosis, data from the RBD group with eventual Parkinson's disease (n equals 11) and the current idiopathic RBD group (n equals 16) were indistinguishable, with two exceptions: the RBD-Parkinson's disease group had a significantly[neurology.org]
    • ’s disease (73) Idiopathic Parkinson’s disease (72) Progressive supranuclear palsy (1) Multiple system atrophy (35) Multiple system atrophy (30) Idiopathic Parkinson’s disease (4) Progressive supranuclear palsy (1) Progressive supranuclear palsy (20)[academic.oup.com]
    Hemiparesis
    • In the absence of tremor, the presentation of parkinsonism may be erroneously diagnosed as hemiparesis.[dartmouth.edu]
    REM Sleep Behavior Disorder
    • Abstract We report longitudinal data on a group of 29 male patients 50 years of age or older who were initially diagnosed as having idiopathic REM sleep behavior disorder (RBD) after extensive polysomnographic and neurologic evaluations.Thirty-eight percent[neurology.org]
    • For years, we have known that other sleep disorders are seen in patients with PD, including insomnia, restless leg syndrome, hypersomnia, and REM sleep behavior disorder.[clinicaladvisor.com]
    • Associated factors for REM sleep behavior disorder in Parkinson disease. Neurology . 2011;77(11):1048–1054. 31. Schenck CH, Mahowald MW. Rapid eye movement sleep parasomnias. Neurol Clin . 2005;23(4):1107–1126. 32.[aafp.org]
    Huntington's Disease
    • ’s disease with depression Take Quiz Diagnosing rare movement disorders Take Quiz Huntington’s disease preliminary diagnosis imaging Take Quiz Transcranial magnetic stimulation & essential tremor Take Quiz Chorea characteristics in Huntington’s disease[mdedge.com]
    • Physicians and scientists at the center are dedicated to improving care and working on research for patients with Parkinson’s disease and other movement disorders, such as Huntington’s disease, dystonia and essential tremor.[uchealth.com]
    • .), Huntington’s disease, Tourette’s Syndrome, tremor, chorea, athetosis, dystonia, ballism, myoclonus, tics, spasticity, rigidity, restless legs syndrome.[bumc.bu.edu]
    • Types of Movement Disorder Treated We evaluate and treat all types of movement disorders, including: Ataxia Blepharospasm and Hemifacial Spasm Drug-induced Movement Disorders Dystonia Essential Tremor and Other Types of Tremor Huntington’s Disease Myoclonus[carolinashealthcare.org]
    • […] and Movement Disorders We Treat We treat Parkinson’s and other conditions that may be related: Ataxia Balance disorders Blepharospasm Cervical dystonia and spasmodic torticollis Corticobasal degeneration (CBGD; parkinsonian disorder) Essential tremor Huntington’s[ohsu.edu]
    Secondary Parkinsonism
    • parkinsonism G21.0 Malignant neuroleptic syndrome G21.1 Other drug-induced secondary parkinsonism G21.11 Neuroleptic induced parkinsonism G21.19 Other drug induced secondary parkinsonism G21.2 Secondary parkinsonism due to other external agents G21.3[icd10data.com]
    • In secondary parkinsonism, the mechanism is blockade of or interference with dopamine ’s action in the basal ganglia.[msdmanuals.com]
    • (Secondary Parkinsonism; Atypical Parkinsonism) By Hector A.[merckmanuals.com]
    • Secondary Parkinsonism. These conditions are caused by other problems. Drug induced parkinsonism.[nwpf.org]
    • Those with recognizable causes or secondary parkinsonism may be due to a variety of factors, some reversible, others resulting in irreversible damage.[verywell.com]

    Etiology

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

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    Summary

    Patient Information

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    References

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    2. A controlled trial of rotigotine monotherapy in early Parkinson's disease - TP GROUP - Archives of neurology(Chicago), 2003 - cat.inist.fr
    3. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy - BF Boeve, MH Silber, TJ Ferman, JA Lucas - disorders, 2001 - Wiley Online Library
    4. A comparison of clinical and pathological features of young‐and old‐onset Parkinson's disease - WRG Gibb, AJ Lees - Neurology, 1988 - AAN Enterprises
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    6. Clinical findings of a myoclonus-dystonia family with two distinct mutations - D Doheny, F Danisi, C Smith, C Morrison, M Velickovic - Neurology, 2002 - AAN Enterprises
    7. Association between essential tremor and Parkinson's disease - JJ Geraghty, J Jankovic, WJ Zetusky - Annals of neurology, 2004 - Wiley Online Library
    8. Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]‐FP‐CIT SPECT imaging: The [123I]‐FP‐CIT study group - HTS Benamer, J Patterson, DG Grosset - Disorders, 2000 - Wiley Online Library
    9. Clinical and acoustical variability in hypokinetic dysarthria - EJ Metter, WR Hanson - Journal of Communication Disorders, 1986 - Elsevier
    10. Articulatory deficits in parkinsonian dysarthria: an acoustic analysis. - H Ackermann, W Ziegler - Journal of Neurology, Neurosurgery & , 1991 - jnnp.bmj.com
    11. EFFECTS OF DOPAMINERGIC AND ANTICHOLINERGIC THERAPIES ON COGNITIVE AND MOTOR FUNCTION IN PARKINSON'S DISEASE A FOLLOW-UP STUDY - JA Cooper, HJ Sagar, SM Doherty, N Jordan - Brain, 1992 - Oxford Univ Press
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    16. A clinical and genetic study of familial Parkinson's disease - DM Maraganore, AE Harding - Disorders, 2004 - Wiley Online Library
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    21. Abnormalities of the spatiotemporal characteristics of gait at the onset of freezing in Parkinson's disease - A Nieuwboer, R Dom, W De Weerdt - Disorders, 2001 - Wiley Online Library
    22. Action tremor and the cogwheel phenomenon in Parkinson's disease - JW Lance, RS Schwab, EA Peterson - Brain, 1963 - Oxford Univ Press
    23. Agraphia and micrographia: clinical manifestations of motor programming and performance disorders - DI Margolin, AM Wing - Acta Psychologica, 1983 - Elsevier
    24. Botulinum toxin A for spasticity, muscle spasms, and rigidity - MA Grazko, KB Polo, B Jabbari - Neurology, 1995 - AAN Enterprises
    25. Akinesia: a syndrome common to parkinsonism, retarded depression, and negative symptoms of schizophrenia - PC Bermanzohn, SG Siris - Comprehensive psychiatry, 1992 - Elsevier
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