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14 Cards in this Set
- Front
- Back
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Pathologic hallmark of Parkinson's
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Lewy body, an intracellular inclusion found in the substantia nigra
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festanating gait?
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walking at increasingly faster speed
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MANAGING CONFUSION AND PSYCHOSIS IN PD
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Prescribe higher doses of one or two drugs, rather than small doses of multiple drugs
Anticholinergics and selegiline provide the least benefit relative to their CNS toxicity Clozapine, olanzapine, and quetiapine have fewer extrapyramidal side effects than other antipsychotic agents |
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Stereotactic lesioning
Of pallidum: Treats contralateral __________ Of thalamus: Treats contralateral _______ |
Stereotactic lesioning
Of pallidum: Treats contralateral dyskinesias Of thalamus: Treats contralateral tremor |
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____________ nucleus stimulation improves tremor, akinesia, rigidity, and gait
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Subthalamic nucleus stimulation improves tremor, akinesia, rigidity, and gait
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MULTIPLE SYSTEM ATROPHY (MSA) (“PARKINSON’S PLUS DISEASE”)
Characterized by parkinsonism plus autonomic symptoms, cerebellar signs, and sometimes myoclonus Upper motor signs, severe dysarthria, stridor, dystonia, and an amyotrophic lateral sclerosis (ALS)–like picture may also be present ___________ _______ often the most disabling symptom |
MULTIPLE SYSTEM ATROPHY (MSA) (“PARKINSON’S PLUS DISEASE”)
Characterized by parkinsonism plus autonomic symptoms, cerebellar signs, and sometimes myoclonus Upper motor signs, severe dysarthria, stridor, dystonia, and an amyotrophic lateral sclerosis (ALS)–like picture may also be present Orthostatic hypotension often the most disabling symptom |
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TREATMENT OF MSA
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Midodrine and fludrocortisone sometimes treat orthostatic hypotension
But can cause supine hypertension—monitor BP Levodopa may initially help motor symptoms but often worsens orthostatic hypertension |
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PROGRESSIVE SUPRANUCLEAR PALSY (1 of 2)
Progressive impairment of voluntary ____ Square wave jerks (small, brief saccadic-appearing eye movements every few seconds on fixation) Rigidity, especially at neck and trunk Disturbed gait; frequent falls in most patients Cognitive impairment and personality changes |
PROGRESSIVE SUPRANUCLEAR PALSY (1 of 2)
Progressive impairment of voluntary gaze Square wave jerks (small, brief saccadic-appearing eye movements every few seconds on fixation) Rigidity, especially at neck and trunk Disturbed gait; frequent falls in most patients Cognitive impairment and personality changes |
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PROGRESSIVE SUPRANUCLEAR PALSY (2 of 2)
Onset usually occurs during late 50s or early 60s Progresses rapidly Marked incapacity in 3 to 5 years Death within __ years No fully effective treatment available Levodopa may partially reduce rigidity, but improvement is generally transient |
PROGRESSIVE SUPRANUCLEAR PALSY (2 of 2)
Onset usually occurs during late 50s or early 60s Progresses rapidly Marked incapacity in 3 to 5 years Death within 10 years No fully effective treatment available Levodopa may partially reduce rigidity, but improvement is generally transient |
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Flowing, continuous, random movement that flits from one part of the body to another
Arises from dysfunction of the striatum |
CHOREA
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Treatment of chorea
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Treated with dopamine blockers
Haloperidol—associated with tardive dyskinesia Reserpine—associated with depression, orthostatic hypotension Metyrosine—associated with somnolence |
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Antipsychotics can cause acute dystonia; treat severe cases with IV __________________ or _________
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Antipsychotics can cause acute dystonia; treat severe cases with IV diphenhydramine or lorazepam
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Tx of TARDIVE MOVEMENT PHENOMENA
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Treatment includes trihexyphenidyl, baclofen, reserpine, or clozapine
Botulinum toxin injections are an option for severe cases with neck jerking or sustained eye closure |
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TREATMENT OF ESSENTIAL TREMOR
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Initial therapy includes β-blockers, primidone, phenobarbital, diazepam, gabapentin, or clozapine
Severe, medically refractory tremor may be treated with deep brain (thalamic) stimulator surgery |
