parkinsonism.pptx
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Dr. Hania Afzal presents a case of a 56-year-old male with a 7-year history of progressive tremors and myalgia. On examination, he has resting tremors in his hands and feet, muscle wasting, and signs of cogwheel rigidity. His CT and MRI brain are normal. The leading differential diagnoses are Parkinson's disease, NPH, and neurodegenerative disorders. He is started on Sinemet and Kemadrine to manage his Parkinson's disease symptoms.
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disease
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Laboratory for Diagnosis, Symptom and \
Illness Management.
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Patient information
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Age: 62 years
Gender: Male
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The causes of Parkinson's disease (PD), the second most common neurodegenerative disorder, are still largely unknown. Current thinking is that major gene mutations cause only a small proportion of all cases and that in most cases, non-genetic factors play a part, probably in interaction with susceptibility genes. Numerous epidemiological studies have been done to identify such non-genetic risk factors, but most were small and methodologically limited. Larger, well-designed prospective cohort studies have only recently reached a stage at which they have enough incident patients and person-years of follow-up to investigate possible risk factors and their interactions.
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Etiology
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4
Risk Factors
Heredity.
Age. (60 or older)
Sex.
Autoimmune factors
Exposure to toxins
5
Thinking difficulties
Depression and emotional changes
Swallowing problems
Chewing and eating problems
Sleep problems and sleep disorders
Bladder problems
Constipation
Blood pressure changes
Smell dysfunction
Sexual dysfunction
fatigue
Associated conditions
6
PATIENT history
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First symptoms appear usually after age of 40 years but have been reported cases in children’s and is called Juvenile Parkinsonism.
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Etiology
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4
Risk Factors
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Sex.
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Depression and emotional changes
Swallowing problems
Chewing and eating problems
Sleep problems and sleep disorders
Bladder problems
Constipation
Blood pressure changes
Smell dysfunction
Sexual dysfunction
fatigue
Associated conditions
6
PATIENT history
Patient is 62 years old, male, Hispanic descendent, recently discharged from US Army after 25 years of service. He is today looking for medical advice after has been notice a little resting tremor in both hands more marked in right hand, also noted slow motion in some movement mainly with changes of position and some incoordination when he walks. He is concerned because his paternal Grandfather died after suffering for many years with Parkinson’ s disease related disabilities, his father died at 43 years old in a motor vehicle accident and no time to development the disease and he hears that Parkinson’s Disease has some genetics implication. His medical history is only remarkable for a 10 years history of well cont.
case presentation on neuroleptic malignant syndrome.pptx
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- 2. Case Presentation By Dr Hania Afzal Resident Medicine
- 3. • Biodata Mr Haroon, a 56 yrs old male pt, retired from air force as W.Off known hypertensive for 32 years, is resident of Sargodha • P/C Presented in OPD with c/o Anxious behavior and difficulty in falling asleep…… for 5 years Progressive tremors for 7 years Myalgia for 7 years
- 4. • HOPC USOH till 2014, when he started noticing tremors in thumbs of both hands, aggravated by stress, improved by involving in some activity and is associated with generalized myalgia. He is taking medications for tremors but symptoms are progressive in nature. Patient is hypertensive for 32 years and is on medications(no workup done for 2ndry HTN)
- 5. • HOPC His wife died in 2017, since then he remains anxious and has to take anxiolytics off and on but not on any regular anti anxiety or anti psychotic medications
- 6. • Past Medical Hx No history of admissions, taking medicine for HTN and tremors • Past Surgical Hx Appendectomy in 1991 • No hx of blood transfusions, allergies, addictions or pets at home
- 7. • Family Hx Positive for DM and HTN, no other disease runs in family • Socioeconomic Hx He has 3 daughters, 1 son and lives in his own home with available facilities
- 8. • Clinical examination A middle aged anxious looking man, well oriented in time, place and person, lying comfortably on hospital bed having resting tremors in hands and feet, nodding head with vitals of BP: 140/80, pulse: 75/min, Temp: afebrile, SaO2 95% on air, BSR: 110mg/dL
- 9. Wasting of muscles of hands and face With coarse resting tremors in hands, sweaty palmer surfaces, but no clubbing, koilonychia, leukonychia, palor, jaundice, lymph nodes, thyroid swelling or pedal edema. JVP was not raised.
- 10. • CNS examination 1. Motor Patient had short stepping/shuffling gait(bradykinesia) with absent arm swing, increased tone(cogwheel rigidity) with intact reflexex, positive Myerson sign(glabellar sign), normal power, absent clonus, fasciculations, cerebellar signs and negative babinski 2. Cranial nerves All cranial nerves are intact 3. Sensory Fine touch, crude touch, 2 point discrimination, temperature, vibration and pain senses are normal with normal corneal, conjunctival reflexes
- 12. • Abdominal examination revealed appendectomy scar with soft nontender abdomen • Chest was bilateral clear • CVS revealed S1, S2
- 13. DDs • Parkinson’s disease • NPH • Neurodegenerative disorder • Wilson • Depression • Essential tremors • Huntington • Multi system atrophy • Supranuclear palsy
- 14. Investigations • CT brain and MRI brain are normal
- 15. Management • Sinemet (carbidopa,levodopa) • Kemadrine (procyclidine)
- 17. What it is….. Any combination of • Tremor • Rigidity • Bradykinesia and • Progressive postural instability Described by James Parkinson in 1817
- 18. Occurs in… • All ethnic groups • Both genders • 45-65 years of age
- 19. Etiology… • Idiopathic • Familial • Postencephalitic • Toxin exposure Mn CS2 • CO poisoning • Neuroleptics
- 20. Pathophysiology… Dopamine depletion 2ndry to degeneration of dopminergic nigrostriatal system Imbalance of dopamine and acetylcholine
- 21. Clinical findings Motor Menifestations • Tremor • Rigidity • Bradykinesia • Postural instability
- 22. • Nonmotor symptoms Affective disorder(depression, anxiety, apathy) Psychosis Cognitive changes/ dementia Fatigue Sleep disorders Anosmia Autonomic disturbance Sensory complaints/pain Seborrhoeic dermatitis
- 23. Signs • Tremor of 4 to 6 cycles/sec(enhanced by stress decreased by voluntary activity) • Rigidity • Bradykinesia • Infrequent blinking • Fix facial expressions • Myerson sign • Sliva drool • Micrographia • Shuffling gait with no arm swing • Tendency to fall
- 24. Treatment • Symptomatic • General Measures • Medical 1. Amantadine 2. Levodopa with carbidopa 3. Dopamine agonists 4. Ropinirole 5. Pramipexole 6. Selective MAO inhibitors(Rasagiline) 7. COMT inhibitors 8. Anticholinergic medications 9. Antipsychotics • Stimulation and ablative treatment • Gene Therapy
Editor's Notes
- Idiopathic(most common form ) occurs in this age slight increased risk in men
- Familial is rare and may result from mutation of several different genes Postencephalitic being increasingly rare
- Tremor starts by one limb Rigidity responsible for flexed posture Bradykinesia( slowing of voluntary movements), and automatic movements but curiously…