Parkinson Disease

Basics

Description

  • Gradual progressive neurologic disorder of middle or late life
  • Degeneration of dopaminergic neurons in the substantia nigra
  • Accelerated cortical atrophy
  • Only definitive diagnosis is on autopsy
  • Can begin unilaterally, but generalizes to symmetric
  • Lifetime risk: 2% in males, 1.3% in females
  • Mean age of onset is 60 yr old
  • May have symptoms 20 yr prior to diagnosis:
    • Nonspecific:
      • Fatigue
      • Constipation
      • Hyposomia

Etiology

  • Sporadic or idiopathic
  • Disorders presenting with parkinsonism:
    • Drug induced:
      • Neuroleptics
      • Antiemetics
      • Chemotherapeutics
      • Amphotericin B
    • Toxins:
      • Carbon monoxide
      • Methanol
      • Cyanide
      • Organophosphate poisoning
      • 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine
    • Brain lesions:
      • Basal ganglia stroke
      • Midbrain lesions
      • Hydrocephalus
    • CNS infections
    • Other:
      • Central pontine myelinolysis
      • Encephalitis lethargica (autoantibodies against basal ganglia antigens)

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