Makindo Medical Notes

Related Subjects:Multiple System Atrophy (MSA) |Parkinson Plus syndromes |Parkinsonism |Idiopathic Parkinson disease |Progressive Supranuclear Palsy |Drug Induced Parkinson disease

About

Note: It is essential to distinguish between "Parkinsonism" and "Parkinson's Disease." Parkinsonism is a broad term describing a clinical syndrome characterized by increased tone, rigidity, tremor, and other features associated with Parkinson's Disease. However, Parkinsonism can occur in various other conditions, including stroke, head injury, and drug-induced states. Parkinson’s Disease (PD) is a distinct, idiopathic neurodegenerative disorder with specific clinicopathological features, while Parkinsonism may be seen in other diseases.

• Parkinsonism is commonly characterized by Tremor, Rigidity, Akinesia, and Postural instability (often referred to as "TRAP").

Most Common Causes

• Parkinson's Disease: The most frequent cause, resulting from the degeneration of dopamine-producing neurons, primarily in the substantia nigra.
• Drug-Induced Parkinsonism: Often caused by medications that block dopamine receptors, such as antipsychotics or certain anti-nausea drugs (e.g., metoclopramide).
• Vascular Parkinsonism: Caused by small strokes or restricted blood flow that affects the areas of the brain responsible for movement.
• Atypical Parkinsonism: Includes other neurodegenerative conditions like progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD), each with unique clinical features and poorer responses to traditional PD treatments.

Other Causes of Parkinsonism

• Idiopathic Parkinson's Disease: A common cause with unknown etiology.
• Cerebrovascular Disease: Small vessel disease, often with accompanying vascular dementia.
• Medications: Dopamine-blocking drugs, such as metoclopramide or antipsychotics.
• Wilson's Disease: A genetic disorder involving copper accumulation, affecting the liver and brain.
• Carbon Monoxide Poisoning: Known to cause basal ganglia damage, leading to parkinsonian symptoms.
• Post-Encephalitic Parkinsonism: Historically seen after encephalitis lethargica (often termed von Economo's encephalitis).
• Head Injury: Chronic trauma, such as in boxers, may lead to parkinsonian symptoms.
• MPTP Toxicity: Exposure to MPTP, a toxic byproduct of synthetic drug production, can lead to irreversible parkinsonism.

Symptoms

• Tremor: Typically a resting tremor, often beginning unilaterally in the hands or arms, that may progress to other parts of the body.
• Bradykinesia: Slowness of movement, leading to difficulties in daily tasks like walking, dressing, and other fine motor tasks.
• Rigidity: Muscle stiffness, making movement feel restricted or "cogwheel-like" when examined.
• Postural Instability: Impaired balance and coordination, often causing frequent falls and difficulty with gait stability.