Presentation
The cause underlying this clinical presentation was identified as the chronic pressure brought forward by the cavernous hemangioma. [ncbi.nlm.nih.gov]
ICD Code ICD Description Total National Projected Hospitalizations - Annualized (Present on Admission - All) Total Medicare Hospitalizations - Oct 2015 to Sep 2018 (Present on Admission - All) Total National Projected Hospitalizations - Annualized (Present [dexur.com]
This case report was presented before at AOPMC 2016, Manila. It has not been published yet. To cite this abstract in AMA style: D. Desai, S. Desai. Rare presentation of acute secondary parkinsonism in the post partum period. [abstract]. [mdsabstracts.org]
Results: Not applicable Conclusions: We present an interesting case of large anterior cranial fossa meningioma with mass effect on the caudate presenting with secondary parkinsonism. [n.neurology.org]
Entire Body System
- Disability
This is when medication doesn’t help as much and serious disabilities set in. [webmd.com]
This condition may lead to these problems: Difficulty doing daily activities Difficulty swallowing (eating) Disability (varying degrees) Injuries from falls Side effects of medicines used to treat the condition Side effects from loss of strength (debilitation [salud.wikiplus.org]
Freezing or periods of akinesia This is one of the disabling symptoms and commonly seen in men, and commonly affects the legs where there are moments of motor blocks in walking. [medicaljoyworks.com]
Surgery Thalamotomy /DPS of the Vim (Ventro intermediate thalamic nucleus) in patients with drug-refractory disabling tremors Pallidotomy/ DBS of the GPi (Globus Pallidus) to improve motor disabilities Grafting/ Transplantation of Porcine human/ [slideshare.net]
Possible Complications This condition may lead to these problems: Difficulty doing daily activities Difficulty swallowing (eating) Disability (varying degrees) Injuries from falls Side effects of medicines used to treat the condition Side effects from [health.firstlighthealthsystem.org]
- Weakness
The patient returned, complaining of generalized weakness. The ED workup this time, comprising laboratory testing and computed tomography of the abdomen and pelvis, was negative. She was given a diagnosis of “cisplatin neurotoxicity.” [mdedge.com]
Common symptoms include: Decrease in facial expressions Difficulty starting and controlling movement Loss or weakness of movement (paralysis) Soft voice Stiffness of the trunk, arms, or legs Tremor Confusion and memory loss may be likely in secondary [salud.wikiplus.org]
History of episodes of inability to talk, weakness of the body These features usually suggest underlying cause for secondary parkinsonism such as stroke. They may give a history of strokes and transient ischemic attacks. [medicaljoyworks.com]
- Pain
Joint pain Patients with PD can develop joint pain due to muscle rigidity. Joint pain Patients with PD can develop joint pain due to muscle rigidity. Postural deformities As the disease progresses patients develop postural deformities. [medicaljoyworks.com]
A pre-parkinsonian state is recognized with insomnia, increase in violent dreams, talking, yelling in sleep. [1] [2] Olfactory dysfunction, Oral pain, akathisia, genital pain [2] These are pre-parkinsonism features and thought to be due to neuronal loss [explainmedicine.com]
Her primary complaints in the ED were “throbbing” in the thighs bilaterally and leg pain. The woman’s postop course had otherwise been uncomplicated. [mdedge.com]
- Impaired Balance
Secondary Parkinsonism and Parkinson Plus Syndromes Similar to Parkinson’s disease, secondary parkinsonism presents with the movement abnormalities of Parkinson’s disease including difficulty with muscle control, impaired balance and rigidity, but parkinsonism [asaging.org]
Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance. Postural instability may lead to falls. [medicinenet.com]
Poor posture and balance that may cause falls; gait or balance problems. Are there other symptoms of PD? Symptoms of Parkinson's disease vary from patient to patient. The symptoms may appear slowly and in no particular order. [columbianeurology.org]
Without enough dopamine, this balance is disrupted, resulting in tremor (trembling in the hands, arms, legs and jaw); rigidity (stiffness of the limbs); slowness of movement; and impaired balance and coordination – the hallmark symptoms of Parkinson's [aans.org]
- Surgical Procedure
Further other approach are developped like surgical procedures: ex : high frequency stimulation of subthalamic nucleus, the more rational target for stimulation in Parkinson's disease. [ncbi.nlm.nih.gov]
Modified treatment strategies (mentioned above) should be considered at this point to improve symptoms and allow for reduced doses of L-dopa.15 Surgery Information on surgical procedures to relieve symptoms of PD may be obtained by contacting the American [uspharmacist.com]
Gastrointestinal
- Nausea
Gastrointestinal prokinetics are prescribed for abdominal discomfort, bloating, constipation, heart burn, nausea, and vomiting. Calcium channel blockers are prescribed for hypertension, angina and arrhythmia. [medicaljoyworks.com]
[…] atrophy Progressive supranuclear palsy Stroke Wilson disease Other causes of secondary parkinsonism include: Brain damage caused by anesthesia drugs (such as during surgery) Carbon monoxide poisoning Certain medicines used to treat mental disorders or nausea [health.firstlighthealthsystem.org]
There are many other causes of parkinsonism (secondary parkinsonism), including: Medications, such as those used to treat psychosis, major psychiatric disorders and nausea Repeated head trauma, such as injuries sustained in boxing Certain neurodegenerative [mayoclinic.org]
Side effects may include heartburn, nausea, dry mouth and dizziness. Confusion, nightmares, hallucinations and headache occur less often and should be reported to the doctor. [aans.org]
Before this ED visit, chemoradiation was complicated by persistent nausea that, eventually, responded to a combination of metoclopramide and prochlorperazine. Deep-vein thrombosis was ruled out in the ED. [mdedge.com]
- Constipation
Gastrointestinal prokinetics are prescribed for abdominal discomfort, bloating, constipation, heart burn, nausea, and vomiting. Calcium channel blockers are prescribed for hypertension, angina and arrhythmia. [medicaljoyworks.com]
Side effects include dry mouth and eyes, constipation, memory problems, confusion and difficulty urinating. [livestrong.com]
[…] may have a greater negative impact on quality of life.3 Nonmotor symptoms include anxiety, depression, confusion, dementia, urinary dysfunction, and excessive daytime sleepiness.7-9 Additionally, impairment of the autonomic nervous system may lead to constipation [uspharmacist.com]
They may also have impotence, and severe constipation and urinary changes. Corticobasal degeneration (CBD): These patients may have a combination of parkinsonism symptoms. [ohsu.edu]
[…] loss that occurs during the first year of the disorder (indicating dementia) Symptoms of parkinsonism on only one side of the body (often due to certain brain tumors or corticobasal ganglionic degeneration) Low blood pressure, difficulty swallowing, constipation [msdmanuals.com]
- Muscle Rigidity
These are due to rigidity of the muscles. Neck and the truck is flexed so as the elbows and the knees. Postural deformities As the disease progresses patients develop postural deformities. These are due to rigidity of the muscles. [medicaljoyworks.com]
These medications are most useful in the treatment of tremor and muscle rigidity, as well as in reducing medication-induced parkinsonism. [aans.org]
Symptoms may include: Muscle rigidity. Stiffness when the arm, leg, or neck is moved back and forth. Resting tremor. Tremor (involuntary movement from contracting muscles) that is most prominent at rest. Bradykinesia. [columbianeurology.org]
Rigidity: Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult. [medicinenet.com]
Cardiovascular
- Orthostatic Hypotension
However, nonmotor symptoms such as hallucinations, orthostatic hypotension, REM-sleep behavior disorder, and anosmia are rarely revealed in VP, which may be noted to another diagnosis or mixed pathology. [ncbi.nlm.nih.gov]
Orthostatic hypotension 2. [slideshare.net]
hypotension and neuropsychiatric adverse effects (e.g., confusion, hallucinations).3,9 As a result, these agents should be avoided in patients with confusion, memory or cognitive impairment, and in patients at risk of hypotension.3,13 While anticholinergics [uspharmacist.com]
Neurologic
- Tremor
Finger tremor Tremor is usually absent in drug induced parkinsonism (DIP), however 30-50% of patients may present with asymmetrical resting tremor. Those patients usually shows postural tremor as well. [medicaljoyworks.com]
Abstract We present a 71 year old woman with predominantly right sided parkinsonism of sudden onset, but without tremor. [ncbi.nlm.nih.gov]
The cogwheel rigidity improved post-resection, but she continued to have a mild right-handed resting tremor without further progression of disease. [n.neurology.org]
Drug therapy for treating associated symptoms Depression Tricyclic antidepressants They exhibit some dopaminergic and anticholinergic effects. Action Tremor ß Blockers-Propranolol Benzodiazepenes Primidone Mild Tremor Antihistamines. [slideshare.net]
- Confusion
Side effects include hallucinations, confusion, dizziness and headaches. [livestrong.com]
Common symptoms include: Decrease in facial expressions Difficulty starting and controlling movement Loss or weakness of movement (paralysis) Soft voice Stiffness of the trunk, arms, or legs Tremor Confusion and memory loss may be likely in secondary [salud.wikiplus.org]
When to Contact a Medical Professional Call the provider if: Symptoms of secondary parkinsonism develop, come back, or get worse New symptoms appear, including confusion and movements that cannot be controlled You are unable to care for the person at [health.firstlighthealthsystem.org]
Symptoms Common symptoms include: Decrease in facial expressions Difficulty starting and controlling movement Loss or weakness of movement (paralysis) Soft voice Stiffness of the trunk, arms, or legs Tremor Confusion and memory loss may be likely in secondary [irmcphysicians.com]
- Motor Symptoms
The clinical features of PD include both the motor symptoms (described above), as well as non-motor issues. [movementdisorders.org]
BACKGROUND: Non-Motor Symptoms (NMS) are frequent in patients with Idiopathic Parkinson's Disease (IPD). [clinicaltrials.gov]
You may have these issues years before any classic motor symptoms like tremors: Constipation Depression Loss of smell Low blood pressure when you stand up Pain Sleep issues You also might get these symptoms later in the disease. [webmd.com]
Parkinson’s is known as a movement or motor disease, but the non-motor symptoms such as depression, sleep abnormalities and slowed thinking (bradyphrenia) can be even more disabling than the more outwardly noticeable motor symptoms of tremors, shuffled [asaging.org]
Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. [medicinenet.com]
- Cogwheel Rigidity
The cogwheel rigidity improved post-resection, but she continued to have a mild right-handed resting tremor without further progression of disease. [n.neurology.org]
Neurological examination revealed left hemiparkinsonism, characterised by mixed tremor (postural, action and intermittent rest tremor) in both extremities, hypomimia, bradykinesia, cogwheel rigidity and loss of arm swing during gait on the left hand side [jnnp.bmj.com]
[…] as "cogwheel rigidity". [medicaljoyworks.com]
She drooled, and had dysarthria, a shuffling gait, and cogwheel rigidity. Medications included metoclopramide, three times daily; prochlorperazine, every 6 hours; omeprazole; and dexamethasone. [mdedge.com]
- Somnolence
Initial symptoms were consistent with a viral infection, including influenza and pharyngeal symptoms with fever followed by a variety of neurological symptoms.11 The majority of patients had ophthalmoplegia in combination with a persistent pathological somnolence [neurology.mhmedical.com]
[…] treated with dopaminergic medication 9,10) bradyphrenia and dementia: generally a late feature in contrast, Lewy body dementia has cognitive impairment either preceding or at most within 12 months of clinical onset of parkinsonian symptoms 2 fatigue and somnolence [radiopaedia.org]
Urogenital
- Urinary Incontinence
Additionally swallowing problems, urinary incontinence can occur. [medicaljoyworks.com]
Additionally gait disturbance, urinary incontinence, and dementia or cognitive decline. The gait disturbance, which is commonly the first symptom, and it's called “glued” or “magnetic” gait. [explainmedicine.com]
So more lower limb is classical of atherosclerotic or vascular Parkinsonism and they also have urinary incontinence associated with this type of Parkinsonism. [youtube.com]
Urinary incontinence or incomplete bladder emptying Criteria Reduction of least 30mmHg or in diastolic blood pressure by at least 15 mm Hg after 3 min of standing urinary incontinence (persistent, involuntary partial or total bladder emptying, accompanied [slideshare.net]
[…] the Urinary Tract Urinary Tract Infection Ureteral Calculi Urinary Tract Obstruction Urinary Disorders Secondary to Other Disease Processes Urinary Incontinence Urinary Retention Neurogenic Bladder Urinary Diversions 5. [play.google.com]
Workup
The ED workup this time, comprising laboratory testing and computed tomography of the abdomen and pelvis, was negative. She was given a diagnosis of “cisplatin neurotoxicity.” No treatment was provided. [mdedge.com]
Treatment
Incorrect diagnoses of depression or catatonia delayed treatment or aggravated the problem. Acute treatment included amantadine, levodopa/carbidopa with or without selegiline, diphenhydramine, or benztropine. [ncbi.nlm.nih.gov]
Our understanding of the pathogenic mechanisms and our treatment options are expanding at a rapid pace. [books.google.de]
There are no specific treatments for DLB. Treatment focuses on symptoms. Drug-induced Parkinsonism This is the most common form of what is known as secondary parkinsonism. [parkinson.org]
For a more detailed description of treatment, see Parkinson's disease. [sites.magellanhealth.com]
Treatment Return to top Treatment is aimed at controlling symptoms. If the symptoms are mild, no treatment may be needed. If the condition is caused by a medication, the benefits of the medication should be weighed against the severity of symptoms. [pacificschoolserver.org]
Prognosis
Outlook (Prognosis) Unlike Parkinson disease, some types of secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Some brain problems, such as Lewy body disease, are not reversible. [health.firstlighthealthsystem.org]
Outlook (Prognosis) Unlike Parkinson disease, secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Brain problems, such as Lewy body disease, are not reversible. [irmcphysicians.com]
Outlook (Prognosis) Unlike Parkinson disease, some types of secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Brain problems, such as Lewy body disease, are not reversible. [stelizabeth.com]
Etiology
Etiologies included hypoxic-ischemic encephalopathy; haloperidol treatment with and without neuroleptic malignant syndrome; toxicity of cytosine arabinoside, cyclophosphamide, amphotericin B, and methotrexate; St. [ncbi.nlm.nih.gov]
Etiology Parkinson disease: PD is commonly considered idiopathic, although several etiologic factors (e.g., genetic predisposition) are being investigated. [amboss.com]
Secondary parkinsonism can be due to metabolic disorders, intoxication, cerebrovascular disorders, head injuries, or infectious etiologies. Intracranial tumor is an established, but rare cause of secondary parkinsonism. [n.neurology.org]
However, a wide range of other etiologies may lead to a similar set of symptoms, including some toxins, a few metabolic diseases, and a handful of neurological conditions other than Parkinson's. [icd.codes]
To date, the etiology of MSA is still elusive, yet a complex interaction incorporating genetic predisposition and environmental factors is suggested to drive disease initiation and progression, as familial aggregation following an autosomal dominant or [movementdisorders.org]
Epidemiology
Epidemiology of Parkinson's disease. Lancet Neurol 2006;5:525-535. 2. Alves G, Forsaa EB, Pedersen KF, Dreetz Gjerstad M, Larsen JP. Epidemiology of Parkinson's disease. J Neurol 2008;255 Suppl 5:18-32. 3. [jkna.org]
Parkinson disease: parkinsonism for which no cause can be determined (idiopathic) References:[1][2] Epidemiology References:[1][3][4][5][6][7] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Author information 1 Dipartimento di Scienze Neurologiche, Sapienza Università di Roma, Rome, Italy. [email protected] Abstract The PRIAMO study is a cross-sectional longitudinal observational study aimed at describing epidemiology and evolution [ncbi.nlm.nih.gov]
Epidemiologic approaches to the study of Parkinson's disease etiology. Epidemiology 1999; 10: 327-336. 13. Tanner CM, Aston DA. Epidemiology of Parkinson's disease and akinetic syndromes. Curr Opin Neurol 2000; 13: 427-430. 14. Calne DB. [ge-bu.nl]
Epidemiology : prevalence of MSA in four studies ranged from 1·9 to 4·9 cases per 100 000 people. similar to those of other well-known neurodegenerative disorders such as Huntington’s disease and motor neuron disease. no single environmental [slideshare.net]
Pathophysiology
Furthermore, they illustrate the metabolic effects related to acute focal lesions of the SN as opposed to the progressive degeneration in idiopathic PD and may serve to help unravel the complicated pathophysiology underlying these conditions. [ncbi.nlm.nih.gov]
Clinical expressions, postulated pathophysiological mechanisms and responsiveness to antiparkinson medication represent differences between IPD and secondary Parkinsonism (SP). OBJECTIVES: To evaluate NMS expressions in IPD, SP and a control group. [clinicaltrials.gov]
We discuss the pathophysiology leading to involvement of substantia nigra and treatment options. [content.iospress.com]
Biology of Parkinson's disease: pathogenesis and pathophysiology of a multisystem neurodegenerative disorder. Dialogues Clin Neurosci. 2004 Sep; 6(3): 259–280. Gazewood JD, Richards DR, Clebak K. Parkinson disease: an update. [parkinsonsdisease.net]
Prevention
People taking medicines that can cause secondary parkinsonism should be carefully monitored by the provider to prevent the condition from developing. [health.firstlighthealthsystem.org]
People taking medicines that can cause secondary parkinsonism should be carefully monitored by the doctor to prevent the condition from developing. References Lang AE. Parkinsonism. In: Goldman L, Schafer AI. [irmcphysicians.com]
Treating underlying conditions, such as stroke or infections, can reduce symptoms or prevent the condition from getting worse. If symptoms make it hard to do everyday activities, the provider may recommend medicine. [stelizabeth.com]