1. Short Case Approach to Parkinson's Disease
1) Comment on mask-like facies, resting/pill rolling tremor & drooling of saliva
2) Rigidity: lead pipe rigidity & cog-wheeling
3) Bradykinesia: ask PT to touch each finger in turn w thumb, ask PT to tap foot
4) Glabellar tap
5) Postural instability: ask PT to get out of chair unaided - PT will have difficulties
6) Gait - difficulties initiating movt, lack of arm swing, stooped posture, festinant gait (chasing after
own centre of gravity), feet scraping floor, turning by numbers.
Parkinson’s Plus Syndromes
7) Progressive supranuclear palsy: upward gaze
8) Multiple Systems Atrophy (if >1 present):
- Striato-nigral Degeneration: pronator drift
- Olivopontocerebellar Atrophy: cerebellar signs
Ask to perform the following:
- Shy-Drager Syndrome: postural hypotension
9) Diffused Lewy-Body Disease: dementia, neuropsychiatric manifestations. Do MMSE
Other features of Parkinsonism:
10) Assess speech
11) Assess handwriting.
Causes of true Parkinsonism
1. Parkinson’s disease / Idiopathic (substantia nigra degeneration)
2. Drug induced (Chlorpromazine, metaclopramide, prochlorperazine)
3. Anoxic brain damage
4. Postencephalitic
5. Drug abusers – toxicity of certain drugs of abuse
6. Multiple system atrophy
7. Progressive supranuclear atrophy
8. Familial
9. Genetic mutation
Differential causes Parkinsonism
1. Essential tremors
2. Feature of a space-occupying lesion
Digitally signed by DR WANA HLA SHWE
DN: cn=DR WANA HLA SHWE, c=MY, o=UCSI
University, School of Medicine, KT-Campus, Terengganu,
ou=Internal Medicine Group, email=wunna.
hlashwe@gmail.com
Reason: This document is for UCSI year 4 students.
Date: 2009.02.24 14:12:12 +08'00'