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Postencephalitic Parkinson Disease

PEP


Presentation

  • It presents new perspectives and rules regarding expert testimony and evidence admissibility occasioned by Daubert and related Supreme Court cases.[books.google.de]
  • Clinical and pathological evidence for this conclusion is presented. Key words Postencephalitic parkinsonism Aging Basal ganglia Encephalitis lethargica This is a preview of subscription content, log in to check access.[link.springer.com]
  • Due to almost total extinction of PEP, repository archival material represents the only source for modern investigations, that up to the present, failed to identify a causaive or transmissible agent.[alzheimer-europe.org]
  • The initial presentation of Parkinson’s disease is varied. Many patients present with either extremity clumsiness, loss of facial expressions, pill rolling tremor, easy fatigability or nonspecific pain.[thebigl.co]
  • Unlike AD in which short term memory is affected early, patients with DLBD present with fluctuating attention and cognition and visual hallucinations.[neuropathology-web.org]
Falling
  • Symptoms and course Bradykinesia, rigidity, hypomimia, postural instability, gait disorders with falls and sialorrhea. Ophthalmoplegia and oculogyric crises.[alzheimer-europe.org]
  • WARNINGS AND PRECAUTIONS Falling Asleep During Activities of Daily Living and Somnolence: Patients treated with levodopa (a component of RYTARY) have reported falling asleep while engaged in activities of daily living, including the operation of motor[rytaryhcp.com]
  • It is especially important to stand behind the patient in case they should fall backwards so that the examiner can catch the patient and prevent a fall.[thebigl.co]
  • Patients with progressive supranuclear palsy have a marked tendency to fall and usually do not experience tremor.[healthcommunities.com]
  • Patients using Rytary may fall asleep during activities of daily living. Avoid sudden discontinuation or rapid dose reduction to reduce the risk of withdrawal-emergent hyperpyrexia.[pharmacytimes.com]
Myxedema
  • Diagnosis Code G21.9 Secondary parkinsonism, unspecified 2016 2017 2018 2019 Billable/Specific Code due to encephalitis G21.3 postencephalitic G21.3 ICD-10-CM Codes Adjacent To G21.3 G13.2 Systemic atrophy primarily affecting the central nervous system in myxedema[icd10data.com]
Overeating
  • Encephalitis lethargica, also known as von Economo’s encephalitis, was a global pandemic that affected more than a million people all over the world from 1915 to 1930.[doi.org]
  • Summary Follow-up data are presented of ten patients with autopsy-proven postencephalitic Parkinson's syndrome (PEP) (mean age at death: 56.0 years) with regard to motor and psychic deterioration over a period of institutional observation between 3 and[link.springer.com]
  • The physician may need to observe the person over time prior to making an accurate diagnosis.[parkinsonsmi.org]
  • This resulted in a need to increase dosages over time.[bjorklundnutrition.net]
  • Parkinson’s disease is chronic in nature (meaning it persists over a long period of time) and progressive (Parkinson’s symptoms normally get worse over time with age).[draxe.com]
Hypomimia
  • Symptoms and course Bradykinesia, rigidity, hypomimia, postural instability, gait disorders with falls and sialorrhea. Ophthalmoplegia and oculogyric crises.[alzheimer-europe.org]
  • PARKINSON’S DISEASE Parkinson’s disease is characterized by a characteristic pill rolling tremor, bradykinesia, mask-like facies with a reduced blinking frequency (hypomimia), simian posture, cogwheel rigidity, gait disturbances, and impaired postural[thebigl.co]
Mask-like Facies
  • PARKINSON’S DISEASE Parkinson’s disease is characterized by a characteristic pill rolling tremor, bradykinesia, mask-like facies with a reduced blinking frequency (hypomimia), simian posture, cogwheel rigidity, gait disturbances, and impaired postural[thebigl.co]
Tremor
  • […] the body Passive suicide: killing oneself through indirect action or inaction, such as no longer taking life-prolonging medications Parkinsonian syndromes: disorders related to PD in that they are characterized by bradykinesia and sometimes rigidity, tremor[books.google.de]
  • No diagnostic test available.Diff. diagnosis: mainly against PD, but significant differences: 1. onset of symptoms in younger age, including children and adults aged 25-40 yrs; 2. rare occurence of rest tremor; 3. progression of disease in discontinous[alzheimer-europe.org]
  • Initial symptoms include hand tremors, limb rigidity, and problems walking. As the disease progresses, cognitive problems may develop and advance into dementia. Dietary sources of nicotine may prove protective.[washington.edu]
  • G25 Other extrapyramidal and movement disorders G25.0 Essential tremor Familial tremor Excludes: tremor NOS ( R25.1 ) G25.1 Drug-induced tremor Use additional external cause code (Chapter XX), if desired, to identify drug.[apps.who.int]
  • A resting pill rolling tremor is often noted. The tremor is often noted early in disease onset and is often unilateral at first. It is important to distinguish the pill rolling tremor from essential tremor.[thebigl.co]
Bradykinesia
  • […] paralyzed in (usually) the lower half of the body Passive suicide: killing oneself through indirect action or inaction, such as no longer taking life-prolonging medications Parkinsonian syndromes: disorders related to PD in that they are characterized by bradykinesia[books.google.de]
  • Symptoms and course Bradykinesia, rigidity, hypomimia, postural instability, gait disorders with falls and sialorrhea. Ophthalmoplegia and oculogyric crises.[alzheimer-europe.org]
  • Parkinson's disease is recognized by the presence of at least three of four cardinal signs: resting tremor, cogwheel rigidity, bradykinesia/akinesia, and postural reflex impairment.[parkinsonsmi.org]
  • Clinical features may include bradykinesia, rigidity, parkinsonian gait, and masked facies. In general, tremor is less prominent in secondary parkinsonism than in the primary form.[hon.ch]
Dystonia
  • Elderly patients suffer from continuous deterioration of motor function with dysphagia, incontinence, Levo-Dopa induced psychoses, dystonia, and cognitive impairment.[alzheimer-europe.org]
  • Calne DB, Lang AE (1988) Secondary dystonia. Adv Neurol 50:9–33 Google Scholar 2. Calne DB, Langston JW (1983) Aetiology of Parkinson's disease. Lancet II:1457–1459 Google Scholar 3.[link.springer.com]
  • […] supranuclear palsy and Guamanian parkinsonism-dementia complex. ( 8453463 ) Geddes JF...Daniel SE 1993 24 Anti-tau-positive glial fibrillary tangles in the brain of postencephalitic parkinsonism of Economo type. ( 8121623 ) Ikeda K...Ikeda K 1993 25 Cranial dystonia[malacards.org]
  • It is also said to be useful for pain that is not associated with dystonia. Botulinum toxin A (Botox) has been used to treat equinovarus and claw dystonia in patients who have these conditions and where other medical therapies have not helped.[enotes.tripod.com]
Resting Tremor
  • No diagnostic test available.Diff. diagnosis: mainly against PD, but significant differences: 1. onset of symptoms in younger age, including children and adults aged 25-40 yrs; 2. rare occurence of rest tremor; 3. progression of disease in discontinous[alzheimer-europe.org]
  • He has a rigid, mask-like expression on his face, a bent-forward, stooped posture and a resting tremor.[articles.latimes.com]
  • Parkinson's disease is recognized by the presence of at least three of four cardinal signs: resting tremor, cogwheel rigidity, bradykinesia/akinesia, and postural reflex impairment.[parkinsonsmi.org]
  • PD is characterized by the presence of resting tremor, rigidity, and bradykinesia, and a good response to levodopa.[enotes.tripod.com]
Akinesia
  • See also: dopamine agonist Akinesia Inability to move ("freezing") or difficulty in initiating or maintaining a body motion. From the Greek a, without, and kinesia, movement.[michaeljfox.org]
  • In uncontrolled studies, two-thirds of patients who received amantadine monotherapy experienced improvements in akinesia, rigidity, and tremor.[enotes.tripod.com]
  • Parkinson's disease is recognized by the presence of at least three of four cardinal signs: resting tremor, cogwheel rigidity, bradykinesia/akinesia, and postural reflex impairment.[parkinsonsmi.org]

Workup

Neurofibrillary Tangle
  • Keywords: astrocytes; encephalitis lethargica; multisytem degeneration; oculogyric crisis; postencephalitic parkinsonism; tauopathy (3R/4R tau); tuft-shaped neurofibrillary tangles Summary Postencephalitic parkinsonism is a progressive neurodegenerative[onlinelibrary.wiley.com]
  • The brain regions affected contain neurofibrillary tangles, similar to those seen in Alzheimer's disease. Nevertheless, the senile plaques common in Alzheimer's disease are not found.[en.wikipedia.org]
  • Neuropathology: multisystem neuronal degeneration and cell loss, with gliosisin many brainstem nuclei, in particular substantia nigra, locus ceruleus, and others with globous neurofibrillary tangles in residual neurons in many subcortical nuclei.[alzheimer-europe.org]
  • Ishii T, Nakamura Y (1981) Distribution and ultrastructure of Alzheimer's neurofibrillary tangles in postencephalitic Parkinsonism of Economo type. Acta Neuropathol (Berl) 55:59–62 Google Scholar 13.[link.springer.com]

Treatment

  • The state of the art in treatment remains roughly the same as it was at the time of the events depicted, the 1960s, although patients with post-encephalitic Parkinsonism lose benefit from their medication far faster than do patients with Parkinson's disease[en.wikipedia.org]
  • Care and treatment Similar to PD. Patients may variably respond to L-dopa therapy. Late complications to be treated like those in PD.[alzheimer-europe.org]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself[nejm.org]
  • Nevertheless, most clinicians admit the superiority of Roemer's 1 treatment with massive doses of atropine and of the so-called Bulgarian treatment. 2 Different as the two therapeutic methods are qualitatively, they have in common the same quantitative[jamanetwork.com]
  • […] parkinsonism. ( 5800856 ) Poser CM...Poland JD 1969 45 Distribution of the brain stem lesions in postencephalitic Parkinsonism. ( 5919815 ) Torvik A...Meen D 1966 46 A CASE OF POSTENCEPHALITIC PARKINSONISM RESPONDING TO COMBINED SURGICAL AND MEDICINAL TREATMENT[malacards.org]

Etiology

  • The precise etiology of this disorder remains a conundrum. Most investigators suspect a viral etiology.[indiana.pure.elsevier.com]
  • Report of an acute case due to coxsackie virus type B 2 and re-examination of the etiologic concepts of postencephalitic parkinsonism. ( 5800856 ) Poser CM...Poland JD 1969 45 Distribution of the brain stem lesions in postencephalitic Parkinsonism. ([malacards.org]
  • Sacks has recently been engaged with the etiology of some of the more mysterious diseases: postencephalitic Parkinson's and color blindness in island populations.[medical-dictionary.thefreedictionary.com]
  • There are many causes of parkinsonism, and although there is a specific pathology under the microscope associated with Parkinson's disease, its cause appears to involve multiple factors and there may in fact be more than one cause or etiology.[parkinsonsmi.org]
  • Withdrawal-Emergent Hyperpyrexia and Confusion: A symptom complex that resembles neuroleptic malignant syndrome (characterized by elevated temperature, muscular rigidity, altered consciousness, and autonomic instability), with no other obvious etiology[rytaryhcp.com]

Epidemiology

  • The investigation of dietary sources of nicotine stems from the puzzling epidemiologic findings that repeatedly show that people who have regularly used tobacco have about half the risk of developing Parkinson’s disease, explained Searles Nielsen.[washington.edu]
  • Secondary parkinsonism, which includes drug-induced parkinsonism and postencephalitic parkinsonism Epidemiologic studies have associated early-life viral infections to postencephalitic PD; case reports, on the other hand, tend to relate viral infections[medical-dictionary.thefreedictionary.com]
  • Studies of identical twins show that most Parkinson's disease is not inherited, and epidemiological studies support a multifactorial model in which both genetic and environmental factors play a role.[parkinsonsmi.org]
  • Epidemiological work and animal experiments support the hypothesis that GPD is caused by a toxic amino acid in the seed of a cycad plant which is used to make flour and is a staple in the local diet.[neuropathology-web.org]
Sex distribution
Age distribution

Pathophysiology

  • Several chapters examine the mechanisms and pathophysiology of neuropathological conditions and discuss the biomechanical basis for neurological injury. Where possible, aging and dating methodology is included for various processes.[books.google.de]
  • They reflect functional organization, and it always hopeful to see that disease follows such patterns, raising the prospect that we can understand (and perhaps one day combat) its pathophysiology.[academic.oup.com]
  • “Should this finding be confirmed ... a particularly great importance would have to be attributed to dopamine's role in the pathophysiology and symptomology of idiopathic Parkinson's disease and postencephalitic parkinsonism.” H. Ehringer & O.[nature.com]

Prevention

  • Exercise and Stress Reduction Getting regular exercise and keeping stress levels low can help decrease inflammation levels and prevent brain cell deterioration.[draxe.com]
  • We commission world-class research and drug discovery to treat and prevent primary tauopathies like progressive supranuclear palsy, as well as secondary ones such as Alzheimer’s disease.[tauconsortium.org]
  • It is especially important to stand behind the patient in case they should fall backwards so that the examiner can catch the patient and prevent a fall.[thebigl.co]
  • “West Nile virus is a preventable disease and although the overall risk for developing lingering and ongoing problems is relatively small, it does occur and you don’t want to take that chance,” Sejvar said. – by Kirsten H.[healio.com]
  • This is because they are capable of decreasing the conversion of dopamine to dopachrome and so preventing the toxic impacts of this and other chrome indoles [Hoffer 1998].” References Awakenings (1990). Film. Directed by: Penny Marshall.[bjorklundnutrition.net]

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